Details

Autor(en) / Beteiligte

• Jorgensen, Jennifer E., MD
• Waljee, Akbar K., MD, MSc
• Volk, Michael L., MD, MSc
• Sonnenday, Christopher J., MD, MHS
• Elta, Grace H., MD
• Al-Hawary, Mahmoud M., MD
• Singal, Amit G., MD, MSc
• Taylor, Jason R., MD
• Elmunzer, B. Joseph, MD

Titel

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

Ist Teil von

• Gastrointestinal endoscopy, 2011-05, Vol.73 (5), p.955-962

Ort / Verlag

Maryland heights, MO: Mosby, Inc

Erscheinungsjahr

2011

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.