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MRCP Vs ERCP: Diagnosis For Biliary Obstruction

MRCP Vs ERCP, Biliary Obstruction
Written by healthphreaks

ERCP means (endoscopic retrograde cholangiopancreatography), whereas MRCP means(Magnetic resonance cholangiopancreatography). MRCP is an alternative to diagnostic ERCP used for investigating biliary obstruction. To truly understand what MRCP and ERCP are, you need to know what biliary obstruction is.

What Is Biliary Obstruction

Also known as bile duct obstruction, results from lots of causes, which include choledocholithiasis (gallstone), tumors, and trauma, like injury after gallbladder surgery, with gallstone being the leading cause.

This is a condition when one of the ducts that carry our bile from the liver to the intestine through the gallbladder is blocked. This blockage can lead to severe complications, if left untreated, including infection. A bile duct obstruction can lead to a buildup of bilirubin in your blood and lead to jaundice.

MRCP Vs ERCP, Biliary Obstruction



Below are some of the common causes of Biliary obstruction includes:

  • Gallstones (are the most common cause of bile duct obstruction)
  • Bile duct or pancreatic cancer
  • Infection of the gallbladder, bile ducts or pancreas
  • Liver disease
  • The formation of Choledochal cyst in one of the ducts
  • Injury/trauma- an injury that occurs during a medical procedure like gallbladder surgery
  • Tumors, cancerous or benign

Risk factors

A history of one of the below factor can increase the risk of Biliary obstruction:

  • gallstones
  • obesity
  • pancreatic cancer
  • chronic pancreatitis
  • History of gallbladder problems
  • recent biliary surgery
  • Taking immunosuppressant medications
  • Recent biliary cancer
  • History of liver cancer or disease
  • abdominal trauma or injury

Signs and Symptoms

The signs and symptoms of a bile duct obstruction will vary from person to person. However, Individuals with biliary obstruction also often experiences:

  • abdominal pain, normally in the upper right abdomen
  • itching
  • fever or night sweats
  • nausea and vomiting
  • Jaundice (yellowing of the skin)
  • tiredness
  • unintentional weight loss
  • Dark urine
  • loss of appetite

Diagnosing Biliary Obstruction

If a biliary obstruction is suspected, the first stage in diagnosis is a physical examination. In which your doctor will try to feel your gallballer. Since Liver problems can cause similar symptoms, you may be asked by your doctor about your drug or alcohol usage or even sexual practices.

Blood tests are done to confirm the diagnosis. The following results would suggest you have a bile duct obstruction

  1. High levels of bilirubin in the blood
  2. High levels of liver enzymes
  3. High levels of alkaline phosphatase

Also, your doctor may recommend any of the following imaging procedures below to confirm the diagnosis:

  • Ultrasound of the abdomen
  • Abdominal CT scan
  • Percutaneous transhepatic cholangiogram (PTCA)
  • Endoscopic Retrograde CholangioPancreatography (ERCP)
  • Magnetic Resonance CholangioPancreatography (MRCP)


Depending on the location and underlying cause of the problem, treatment aims to relieve the blockage. Gallstone is the most common cause, and doctors usually remove it by making use of an endoscope during an ERCP. Some patients may require surgery to get rid of the choledocholithiasis.

If the cause of this condition is found to be cancer, the ducts may need to be drained either by making use of an endoscope or perhaps by placing a needle through your skin. Depending on the type of cancer, location, and size; your doctor can treat the cancer by using both chemotherapy and radiotherapy methods.

If Biliary obstruction is left untreated, it can lead to life-threatening infections. They can also lead to chronic diseases like biliary cirrhosis.

MRCP Vs ERCP: Differences in the Procedure

Magnetic resonance cholangiopancreatography is an alternative to diagnostic Endoscopic retrograde cholangiopancreatography for imaging the biliary tree as well as investigating biliary obstruction.

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Endoscopic retrograde cholangiopancreatography is an invasive procedure where surgical cut (incision) is required on the body while Magnetic resonance cholangiopancreatography is non-invasive; which means procedures are done externally using a machine which generates a magnetic field.

MRCP Vs ERCP, Biliary Obstruction

MRCP is not a therapeutic procedure, while ERCP is used for both diagnoses and also for treatment.

Endoscopic retrograde cholangiopancreatography involves the use of a contrast dye injected into the duct of the pancreas while images are being taken While MRCP doesn’t require any dye, as it is an entirely non-invasive procedure.

In ERCP, images are viewed through a fluoroscope. Physicians can see the inner part of the stomach, duodenum, and the pancreas through the combination of the endoscope and the fluoroscope. MRCP involves generating a magnetic resonance field generated through an MRI machine that takes images around the patient.

MRCP helps in visualizing the bile and the pancreatic ducts, and this is not possible for an individual undergoing ERCP.

ERCP is more expensive than MRCP

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MRCP Vs ERCP: Importance & Uses

Endoscopic retrograde cholangiopancreatography is majorly used for diagnosing and also treating abnormalities of the pancreatic ducts and the bile ducts like choledocholithiasis.

Fluoroscopy is used to check for lesions, blockages, and stones. Endoscopic retrograde cholangiopancreatography is also used for the treatment of obstructive jaundice, and gallbladder or a pancreatic tumor.

MRCP helps in visualizing the bile and the pancreatic ducts. The use of MRCP in diagnosing bile duct obstruction may avoid the use of unnecessary invasive procedures like ERCP.

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Magnetic resonance cholangiopancreatography is particularly useful where Endoscopic retrograde cholangiopancreatography(ERCP) is difficult, impossible, or hazardous. MRCP a crucial option for people with failed ERCPs.


The Development of Pancreatitis is a significant risk for Endoscopic retrograde cholangiopancreatography (ERCP), whereas Magnetic resonance cholangiopancreatography (MRCP) does not possess any such complications. Also, Low blood pressure levels may be another risk factor for ERCP.


Considering the risks, cost, and also the complications involved, MRCP is preferred more these days compared to ERCP.

Note: An individual who has experienced previous allergic reaction (like anaphylaxis) because of the dye used cannot undergo ERCP procedure. Magnetic resonance cholangiopancreatography cannot opted for individuals who have gone through past stent surgery. This is it on MRCP Vs ERCP.

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