Impact of dominant stenoses on the serum level of the tumor marker CA19-9 in patients with primary sclerosing cholangitis.
OBJECTIVE
Patients with primary sclerosing cholangitis (PSC) have an increased risk of developing hepatobiliary tumors. The tumor marker CA19-9 was claimed to indicate the occurrence of bile duct carcinoma. This study aimed to assess whether increased serum levels of CA19-9 in PSC patients with dominant stenoses indicate bile duct carcinoma.


METHODS
The study cohort comprised 106 patients treated over a median time of 5.0 years (range 0.5 - 13 years). All patients were treated with ursodeoxycholic acid (UDCA) and whenever they developed dominant stenoses by endoscopic dilatation of these stenoses. In endoscopically treated patients, CA19-9 levels were measured before and 3, 6, 12 and 24 months after endoscopic dilatation.


RESULTS
Of the 106 patients, 22 carcinoma-free patients and 3 patients with bile duct carcinoma had elevated CA 19 - 9 levels. In 14 out of 25 patients with elevated CA19-9 levels, dominant stenoses were diagnosed and treated by endoscopic dilatation. In 71.4 % of the endoscopically treated patients, CA19-9 levels decreased following the endoscopic intervention.


CONCLUSIONS
In PSC patients, increased serum levels of CA19-9 are rarely due to the development of bile duct carcinoma. In patients with dominant stenoses, the relief of biliary obstruction by endoscopic dilatation may lead to a decrease of the serum levels of CA19-9.
Abteilung für Gastroenterologie, Medizinische Klinik IV, Universitätskliniken Köln, Germany. Christine.Benz@web.de
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Petersen-Benz
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Stiehl
D001650:Bile Duct Neoplasms / Q000097:blood* / Q000209:etiology / Q000517:prevention & control; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D002756:Cholagogues and Choleretics / Q000008:administration & dosage; D015209:Cholangitis, Sclerosing / Q000097:blood* / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000097:blood / Q000150:complications / Q000628:therapy; D004106:Dilatation / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid