Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis - 11/08/11
Reprint requests: Jennifer E. Jorgensen, MD, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, Michigan 48109-5362Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : ERC, OLT, QUADAS
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Jorgensen at jjorg@umich.edu. |
Vol 73 - N° 5
P. 955-962 - mai 2011 Retour au numéro
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