title: Evaluation of the bilio-pancreatic region using endoscopic ultrasonography in patients referred with and without abdominal pain and CA 19-9 serum level elevation.
abstract: 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.
authors.affiliation: Service of Digestive Disease, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. ullarojl@terra.es
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ulla Rocha
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Alvarez Sanchez
authors.forename: Javier
authors.initials: J
authors.lastname: Paz Esquete
authors.forename: Estela
authors.initials: E
authors.lastname: Fernandez Salgado
authors.forename: Carlos
authors.initials: C
authors.lastname: Alvarez Alvarez
authors.forename: Manuel Javier
authors.initials: MJ
authors.lastname: Vazquez Sanluis
authors.forename: Luis
authors.initials: L
authors.lastname: Ledo Barro
authors.forename: Enrique
authors.initials: E
authors.lastname: Vazquez Astray
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen