ABSTRACT
Acute pancreatitis (AP) is responsible for over one-quarter of a million hospital admissions in the United States annually, and its incidence is increasing in the United States and Europe. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive technique that is more sensitive than ultrasound and computed tomography (CT) as a modality to diagnose choledocholithiasis. This advantage, however, is encumbered by higher financial costs and a potential delay in more invasive therapeutic intervention. In conclusion, a selective approach that combines abnormal liver function tests and screening ultrasound criteria seems prudent to identify a population presenting with ABP appropriate for early up-front CCY or ERCP, eliminating the need for MRCP and reducing LOS. When utilized more conservatively, MRCP can avoid the need for invasive preoperative ERCP or the need for intraoperative IOC. Adherence to these evidence-base protocols represents an avenue to reduce costs and LOS while eliminating unnecessary expensive MRCP in certain circumstances and enhancing its efficacy in others.
