Suspected Biliary Obstruction Clinical Trial
The main objective of this study is to assess the effectiveness and costs of magnetic resonance cholangiopancreatography (MRCP) and compare it to endoscopic retrograde cholangiopancreatography (ERCP) in the work up of patients with suspected bile duct obstruction on ultrasound. The investigators do not anticipate that a universal recommendation for a given diagnostic test (MRCP versus ERCP) will be applicable in all patients presenting with bile duct obstruction. Rather, the investigators hope to provide quantitative and comparative data relevant to the different clinical situations likely to be encountered in practice, in order to assist physicians in choosing the appropriate diagnostic modality. More specifically, the investigators feel that patients with intrahepatic or hilar obstruction (particularly those with malignant conditions), and those with partial common bile duct (CBD) obstruction (to rule out suspected choledocholithiasis) will benefit most from this new technology and the avoidance of an unnecessary ERCP to further determine the biliary anatomy.
The approach to investigation and management of intermediate-risk biliary obstruction is
controversial. Both magnetic resonance cholangiopancreatography(MRCP)and endoscopic
retrograde cholangiopancreatography (ERCP) are used interchangeably in practice, with little
literature to support the efficacy of one versus the other.
The purpose is to assess the effectiveness of MRCP compared to ERCP in the initial work-up
of patients at intermediate risk of suspected biliary obstruction following initial clinical
assessment and ultrasonography.
A randomized medical effectiveness study was conducted across three tertiary care hospital
sites. Patients at intermediate risk of biliary obstruction were randomized to either ERCP
or MRCP based on level of obstruction as seen by ultrasound (US).
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment