To : cysts and MRCP

[Guest guest]

Hi ,

I just did a quick literature search and found nothing linking

ovarian cysts with any kind of pancreatic disease and then tried

endo with pancreatitic disease....nothing. I am going to try to

figure out if there is another way of describing these diseases to

see if information shows up then. I found out the hard way that if

you do not have the exact disease or illness in mind that you can

search forever and not find the information that is out there. I will

try other combinations yet and other databases.

As far as the MRCP - that is just an MRI that looks at the biliary

system and pancreas more closely. There is also different types

of MRCPs like a MRCP - CCK that uses an IV hormone to

stimulate the gallbladder to contract and bile release and MRCP

- secretin which is an IV hormone to stimulate the pancreas to

release juice. Injecting these hormones via IV helps visualize the

ducts and can cause blockages to become more apparent. A lot

of times, blocks and dilations are not visible until after the fluid

flows. Under resting conditions the blockage may not be

impeding the flow so it does not stand out. The MRCP is the

non-invasive form of ERCP. The benefits is that there is no risk

to the patient (other than claustrophobia and risk of IV if the

hormones are used); the drawbacks are that if a problem is

found, it cannot be treated immediately like an ERCP can do,

and that it is not as accepted yet as the " gold standard " . As far as

your insurance company, it seems that they are following a

slightly questionable " pyramid " of imaging modalities that was

set up some time ago before the MRCP became more

acceptable and cost effective. It is / was thought that a work-up

for CP should start with plain x-ray (if calcifications are present

then this will show it - however, you need to be in advanced

stages of CP to have this show up usually - an usually alcoholic

CP); then if the plain film x-ray is negative, you go to ultra sound

or CT; if this is negative; you go to MRCP; then to ERCP - all

depending on the clinical picture of course. The problem is that

this protocol was founded on alcoholic CP I think, which we all

know, can have different presentations than other forms of CP.

But the insurance company is hoping that the " cheaper "

modalities will show something so that they do not have to pay

for the more expensive or experimental ones. Unbeknowned to

them, most cases of early stage CP usually requires an ERCP to

get to the bottom of things. But like most of medicine, everything

is based on statistics; not necessarily common sense or the

exceptions.

Laurie