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Canadian Journal of Gastroenterology
Volume 22, Issue 1, Pages 55-60
http://dx.doi.org/10.1155/2008/751950
Original Article

Postprocedural Interpretation of Endoscopic Retrograde Cholangiopancreatography by Radiology

Nitin Khanna,1 Gary May,2 Sydney Bass,3 Marty Cole,3 and Joseph Romagnuolo4

1Department of Medicine (Division of Gastroenterology), University of Western Ontario, London, Canada
2Department of Medicine (Division of Gastroenterology), University of Toronto, Toronto, Ontario, Canada
3Department of Medicine (Division of Gastroenterology), University of Calgary, Calgary, Alberta, Canada
4Departments of Medicine (Division of Gastroenterology and Hepatology) and of Biometry, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA

Received 8 March 2007; Accepted 16 July 2007

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: With the increase in the use of endoscopic retrograde cholangiopancreatography (ERCP) (necessitating real-time interpretation), it is unknown whether post-ERCP radiologist reporting is still necessary or helpful.

OBJECTIVES: To determine the rate of discrepancy of results, and the rate of clinically relevant misses and additions, by the radiology report in a blinded setting.

METHODS: A retrospective analysis of the procedure and blinded postprocedure radiology reports of 100 consecutive ERCP cases was performed. A list of clinically relevant pathology and subgroups was made a priori. Discrepancies are described as proportions, with 95% CIs. The radiology yield regarding pathology that was clearly demonstrated at ERCP (bile leaks and stones removed) was calculated. Clinical follow-up was used to clarify additional abnormalities reported by radiology.

RESULTS: Clinically relevant discrepancies in report pairs occurred in 29.0% of cases (95% CI 20% to 39%), or 40.0% if discrepancies regarding bile duct dilation are considered (95% CI 30% to 50%). In 15 of 30 cases (50.0% [95% CI 31% to 69%]) in which bile duct stones were removed, the radiologist did not report a stone. The radiologist did not report five of eight bile leaks (62.5% [95% CI 24% to 91%]). In seven cases (7.0% [95% CI 2.9% to 13.9%]), an additional abnormality was noted by radiology, including a biliary stricture, bile duct and pancreatic duct stones, as well as sclerosing cholangitis. However, during a mean follow-up period of 5.6 months, it appeared that these radiology interpretations were likely incorrect. Discrepancy rates did not vary among the ERCP attendings or by radiology volume.

CONCLUSIONS: Discrepancies between endoscopists’ and radiologists’ ERCP reports are common. Blinded radiology interpretation frequently misses important pathology, and falsely positive additional diagnoses may be made.