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Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Jorgensen, Jennifer E. Waljee, Akbar K. Volk, Michael L. Sonnenday, Christopher J. Elta, Grace H. Al-Hawary, Mahmoud M. Singal, Amit G. Taylor, Jason R. Elmunzer, B. Joseph
Description	Country affiliation: United States Author Affiliation: Jorgensen JE ( Department of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan 48109-5362, USA. jjorg@umich.edu)
Abstract	BACKGROUND: Biliary complications are the second leading cause of morbidity and mortality in orthotopic liver transplant (OLT) recipients. Endoscopic retrograde cholangiography (ERC) is considered the diagnostic criterion standard for post-orthotopic liver transplantation biliary obstruction, but incurs significant risks. OBJECTIVE: To determine the diagnostic accuracy of MRCP for biliary obstruction in OLT patients. DESIGN: A systematic literature search identified studies primarily examining the utility of MRCP in detecting post-orthotopic liver transplantation biliary obstruction. A meta-analysis was then performed according to the Quality of Reporting Meta-Analyses statement. SETTING: Meta-analysis of 9 studies originally performed at major transplantation centers. PATIENTS: A total of 382 OLT patients with clinical suspicion of biliary obstruction. INTERVENTIONS: MRCP and ERCP or clinical follow-up. MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of MRCP for diagnosis of biliary obstruction. RESULTS: The composite sensitivity and specificity were 0.96 (95% CI, 0.92-0.98) and 0.94 (95% CI, 0.90-0.97), respectively. The positive and negative likelihood ratios were 17 (95% CI, 9.4-29.6) and 0.04 (95% CI, 0.02-0.08), respectively. LIMITATIONS: All but 1 included study had significant design flaws that may have falsely increased the reported diagnostic accuracy. CONCLUSIONS: The high sensitivity and specificity demonstrated in this meta-analysis suggest that MRCP is a promising test for diagnosing biliary obstruction in patients who have undergone liver transplantation. However, given the significant design flaws in most of the component studies, additional high-quality data are necessary before unequivocally recommending MRCP in this setting.
File Format	HTM / HTML
ISSN	00165107
Issue Number	5
Volume Number	73
e-ISSN	10976779
Journal	Gastrointestinal Endoscopy
Language	English
Publisher	Elsevier
Publisher Date	2011-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Gastroenterology Cholangiopancreatography, Endoscopic Retrograde Methods Cholangiopancreatography, Magnetic Resonance Cholestasis Diagnosis Liver Transplantation Adverse Effects Etiology Humans Postoperative Complications Sensitivity And Specificity Transplantation, Heterotopic Journal Article Meta-analysis Review
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Gastroenterology

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