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


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ulla Rocha
Jose Luis
JL
Service of Digestive Disease, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. ullarojl@terra.es
Alvarez Sanchez
Maria Victoria
MV
Paz Esquete
Javier
J
Fernandez Salgado
Estela
E
Alvarez Alvarez
Carlos
C
Vazquez Sanluis
Manuel Javier
MJ
Ledo Barro
Luis
L
Vazquez Astray
Enrique
E
D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000473:pathology; D000208:Acute Disease; D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D014408:Biomarkers, Tumor / Q000097:blood; D044963:Biopsy, Fine-Needle; D018395:CA-19-9 Antigen / Q000097:blood*; D019160:Endosonography; D006801:Humans; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen