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Difference between ERCP and MRCP

ERCP and MRCP

Definition:

ERCP stands for Endoscopic Retrograde Cholangio-Pancreatography whereas MRCP stands for Magnetic Resonance Cholangio-Pancreatography.

Differences in the Procedure:

ERCP is an invasive procedure where incision is required on the body whereas MRCP is non-invasive i.e. done externally utilizing a machine that generates a magnetic field. ERCP consists of inserting a fibre-like tube called as an endoscope with a camera attached at one end, through the mouth uptill the pancreas and then viewing the inside of the gastrointestinal tract with the help of fluoroscope. Once the endoscope reaches beyond the stomach till the gall bladder, a dye is injected into the duct of the pancreas and viewed through a fluoroscope. The endoscope and the fluoroscope combined allow the physician to view the inner aspects of the stomach, pancreas and the duodenum.

MRCP consists of creating a magnetic resonance field generated by an MRI machine around the patient that then takes images which aid the diagnostic process.

ERCP involves the use of a contrast dye to be inserted while images are being taken whereas a dye is not used in MRCP as it is a completely non-invasive procedure.

Importance

ERCP is mainly used for diagnosing as well as treating abnormalities of the bile ducts and the pancreatic ducts such as gall stones, inflammatory strictures and leaks. ERCP is considered a boon for the dilatation of the sphincter due to the advent of endoscopy allowing insertion of small metal stents in collapsed ducts.

Fluoroscopy is used to check for blockages, lesions and stones. ERCP is also used for the treatment of obstructive jaundice, stricture of various bile ducts and pancreatic or gall bladder tumour.

MRCP is more often used with a diagnostic point of view whereas ERCP is more often used for therapeutic purposes. MRCP is preferred as it is non-invasive and can help in diagnosing a particular condition. MRCP helps to visualize the bile and the pancreatic ducts as well as the surrounding soft tissues which is not possible in a person undergoing ERCP. Gone are the days when people used to opt for basic operative procedures with simple operations, as now better operative procedures like ERCP and MRCP have come up.

ERCP is more expensive than MRCP but both the procedures are tremendously helpful to physicians to make an accurate diagnosis.

Contra indications

ERCP cannot be done in persons who have undergone previous allergic reaction (anaphylaxis) due to the dye used or in persons who have a history of myocardial infarction. Clotting disorders are another set of conditions which do not allow employment of ERCP. MRCP cannot be opted for in persons who have undergone previous stent surgery or have a pacemaker implanted as the magnetic resonance will interfere in the working of the pace maker.

Risk

Development of Pancreatitis is a major risk for ERCP whereas MRCP does not have any such complications. Low blood pressure may be another risk factor for ERCP.

Summary:

ERCP is done with the use of laparoscopy and fluoroscopy whereas MRCP is done with the use of magnetic resonance machine. ERCP involves the use of dye injection whereas MRCP does not involve the use of a contrast dye.

ERCP is preferred less these days as against MRCP considering the cost, risks and the complications involved in such a highly invasive procedure.


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2 Comments

  1. so impressive ,and knowledgeable artical/ discreption

  2. My wife has undergone esophagectomy, 2 years back, and now is getting severe upper abdomen pain. PET CT is done and indicated everything is normal. Endoscopy is carried out and H- pilory is diagnosed. Earlier ( 1 year back) gall stones were found and are small in size. Now Doctor asked to undergo MRCP for upper abdomen and Pancreatis. Is removal of gall bladder causes any problems for esophagectomy patients?. Why is she getting pain, due to gall stones or H- pylori?. Does MRCP reveal the cause of abdomen pain?. Any advise is welcome.

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References :


[0]http://upload.wikimedia.org/wikipedia/commons/c/c5/ERCP_dilatation.png

[1]http://www.pancan.org/wp-content/uploads/2014/04/MRCP_Image_1.jpg

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