Evaluation of the bilio-pancreatic region using endoscopic ultrasonography in patients referred with and without abdominal pain and CA 19-9 serum level elevation

When assessing the bilio-pancreatic region, collating the findings of serum CA 19-9 values together with findings from various imaging tests--especially endoscopic ultrasonography--is not a simple issue in daily clinical practice. To assess the usefulness of endoscopic ultrasonography in an Endoscop...

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Bibliographic Details
Published in:	Journal of the Pancreas Vol. 8; no. 2; pp. 191 - 197
Main Authors:	Ulla Rocha, Jose Luis, Alvarez Sanchez, Maria Victoria, Paz Esquete, Javier, Fernandez Salgado, Estela, Alvarez Alvarez, Carlos, Vazquez Sanluis, Manuel Javier, Ledo Barro, Luis, Vazquez Astray, Enrique
Format:	Journal Article
Language:	English
Published:	Italy 10-03-2007
Subjects:	Abdominal Pain - diagnostic imaging Abdominal Pain - pathology Acute Disease Adenocarcinoma - diagnostic imaging Adenocarcinoma - pathology Biliary Tract Diseases - diagnostic imaging Biliary Tract Diseases - pathology Biomarkers, Tumor - blood Biopsy, Fine-Needle CA-19-9 Antigen - blood Endosonography Humans Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - pathology Pancreatitis, Chronic - diagnostic imaging Pancreatitis, Chronic - pathology Retrospective Studies
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Summary:	When assessing the bilio-pancreatic region, collating the findings of serum CA 19-9 values together with findings from various imaging tests--especially endoscopic ultrasonography--is not a simple issue in daily clinical practice. To assess the usefulness of endoscopic ultrasonography in an Endoscopic Ultrasonography Unit in two situations: patients with asymptomatic elevation of serum CA 19-9 and patients who presented with abdominal pain plus elevation of CA 19-9. A retrospective study of those patients who underwent radial endoscopic ultrasonography between October 2004 and September 2005 in our institution, considering an elevation of CA 19-9 (equal to or greater than 37 U/mL) with or without symptoms. In each case, the parameters recorded were: levels of CA 19-9 one week before EUS, results from other imaging techniques (US, helical CT), and final diagnosis according to pathological and/or clinical evolution criteria. Patients with previous attacks of acute pancreatitis and also those who presented with bile duct dilation or space-occupying lesions in image studies (US and CT) were excluded. Twenty-two patients met the inclusion criteria. Asymptomatic elevation of CA 19-9 was found in 15 patients while 7 patients had elevated CA 19-9 levels as well as pain of uncertain origin. The results of EUS in the asymptomatic patients were: chronic pancreatitis in 7 patients, no pancreatic alterations in 3 patients, and renal cysts, choledocholithiasis, microlithiasis and liver cirrhosis in one patient, respectively. In patients with abdominal pain, EUS showed chronic pancreatitis in 6 cases and adenocarcinoma of the tail of the pancreas in the remaining patient. When EUS was indicated for the asymptomatic elevation of CA 19-9, the main findings were benign diseases. EUS was useful in studying patients with idiopathic abdominal pain and a slight elevation of CA 19-9 since it allowed us to detect chronic pancreatitis and even early adenocarcinoma of the pancreatic tail.
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ISSN:	1590-8577