Abbreviations Magnetic resonance cholangiopancreatography : MRCP Endoscopic retrograde cholangiopancreatography : ERCP Common bile duct : CBD Ultrasonography : US Computed tomography : CT Endoscopic sphincterotomy : ES Intraoperative cholangiography : IOC Introduction Acute pancreatitis is an abdominal emergency that can be associated with significant morbidity and mortality. Biliary stone disease accounts for 40% of all patients with acute pancreatitis and is the most common aetiolo- gy (1). Although it is not entirely clear how a gallstone may cause pancreatitis, the widely accepted explanation is that progressive pancreatic inflammation caused by sustained biliopancreatic obstruction is induced by the gallstone. In many occasions, the irritating biliary stones cannot be identified, since they can pass through the ampulla into the duodenum. However, the ampullary oedema caused by the passage and temporary impaction of stones could be the real cause of the enduring obstruc- tion (2). Therefore, advocates of early endoscopic inter- vention have used the rationale that the procedure relieves the obstruction and therefore prevents sub- sequent worsening of the clinical presentation. The lim- ited number of prospective randomised trials document- ing the role of early endoscopic ductal clearance in the initial management of patients with severe biliary pan- creatitis does not allow us to draw firm conclusions (3- 5). The benefit of early endoscopic intervention in patients with mild pancreatitis is even weaker, since the pancreatitis generally resolves spontaneously within sev- eral days. Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the standard modality for the diagnosis of bile duct stones. It requires an advanced endoscopy unit with a highly skilled endoscopist. This technique has the advantage of offering therapeutic pro- cedures at the time of diagnosis, if required. However, the risks associated with the procedure limit its use. There is an additional risk of unsuccessful cannulation in 5-10% of the patients (6, 7). Therefore, the use of less invasive methods like endoscopic ultrasonography (EUS) and MR cholangiopancreatography (MRCP) as the initial investigation in suspected common bile duct calculus were instituted (8, 9). Although several studies Acta Chir Belg, 2012, 112, 359-364 “Diagnostic Value of MRCP in Biliary Pancreatitis : Result of Long-Term Follow-up” I. Okan 1 , G. Bas 1 , M. Sahin 1 , O. Alimoglu 1 , R. Eryilmaz 1 , O. V. Ozkan 3 , Z. I. Hasiloglu 2 , A. Akcakaya 1 1 Department of Surgery, 2 Department of Radiology, Vakif Gureba Training and Research Hospital, Istanbul, Turkey; 3 Department of General Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay,Turkey. Abstract. Aim : Magnetic resonance cholangiopancreatography (MRCP) has increasingly been used to evaluate the common bile duct. This study was to determine the role of MRCP instead of endoscopic retrograde cholangio- pancreatography (ERCP) in the management of patients with acute biliary pancreatitis. Methods : A total of 81 patients with mild or moderate biliary pancreatitis who underwent MRCP and were treated in our department with selective ERCP between May 2001 and July 2007 were entered into a prospective database. Results : MRCPwas considered abnormal in 13 patients. Ten patients underwent ERCP. Three patients did not undergo ERCP due to protocol violations. In nine patients, stone extraction was performed. The remaining patient who had dilata- tion of the CBD underwent ES. The false positive rate of MRCP was 10%. The median follow-up of overall patients was 36 months (range 23-99 months). The patients with normal MRCP had a median follow-up of 39.5 months (range 23-99 months). During the follow-up period in the normal MRCP group, five patients were diagnosed with recurrent biliary pancreatitis, of which three under- went ERCP (7.4%). There was no disease-related mortality during this period. Conclusion : In conclusion, the use of MRCP in acute biliary pancreatitis is safe and may be recommended as a tool to aid in the selective use of ERCP. Previous presentations : Preliminary results of this study were presented at the Fifth National Congress of Trauma and Emergency Surgery in Antalya in November 16-20, 2005.