EGS P12 To Perform Magnetic Resonance Cholangiopancreatography or Not in Gallstone Pancreatitis? – A Single Centre Retrospective Cohort Study

Abstract

Abstract Background The management of gallstone pancreatitis (GSP) is well-described in guidelines from the Association of Upper Gastrointestinal Surgeons (AUGIS) and British Society of Gastroenterologists (BSG). Guidelines recommend laparoscopic cholecystectomy (LC) for mild GSP within 2 weeks of the admission, with endoscopic retrograde cholangiopancreatography (ERCP) as second-line for unfit patients. Magnetic resonance cholangiopancreatography (MRCP) plays a pivotal role in excluding choledocholithiasis. Our aim was to determine if MRCP is required to rule out choledocholithiasis in patients with GSP. Methods A retrospective cohort study of all consecutive adult patients who had MRCP for GSP in a single centre from September 2020 to September 2022 was conducted. Patient demographics, pre-MRCP peak liver function test (LFT) values and MRCP findings were analysed. Patients were risk-stratified based on modified AUGIS guidelines using the presence of hyperbilirubinaemia and the presence of biliary duct dilation on other imaging modalities. Patients with MRCP-proven choledocholithiasis were compared to those without. P-values were calculated using Fisher’s exact test. This study was registered with Clinical Quality Project (LanQIP 14738). Results 138 patients were identified; median age was 61 years (IQR 45-73) and 95 (68.8%) were female. 20 (14.5%) patients were post-cholecystectomy. 115 (83.3%) had inpatient scans and 66 (47.8%) were urgent. Median waiting time for inpatient MRCPs was 1.1 days (IQR 0.8-1.9) and 22.9 days (IQR 13.4-28.0) for outpatient scans. 25 (78.1%) patients had raised alkaline phosphatase levels and 23 (71.9%) had hyperbilirubinaenia. 61.1% of abdominal ultrasounds and 38.5% of CT scans reported dilated bile ducts. MRCP yielded 32 patients (23.2%) with choledocholithiasis, 3 of whom were post-cholecystectomy. Choledocholithiasis on MRCP was strongly correlated to higher risk stratification. Conclusions MRCP is useful imaging modality determining the presence of choledocholithiasis in high and moderate risk patients with GSP. We recommend that intraoperative cholangiography should still be performed during laparoscopic cholecystectomy where expertise is available.