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

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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Jorgensen JE,Waljee AK,Volk ML,Sonnenday CJ,Elta GH,Al-Hawary MM,Singal AG,Taylor JR,Elmunzer BJ

doi

10.1016/j.gie.2010.12.014

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

955-62

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)02452-1

journal_volume

pub_type

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