Value of CA 19 9 in cases of cholestasis

In our study,we investigated 52 patients,who have been diagnosed as bile duct obstruction by clinical and radiological examination in order to evaluate how much CA 19-9,a spesific and sensitive marker for pancreatico-biliary malignancies,is elevated in benign bile duct obstructions and wherher it can be used in the differential diagnosis of benign and malignant bile duct obstructions.ERCP was used to provide bile duct drainage of the cases.We studied white blood cell count, ESR (erythrocyte sedimentation rate), CRP, AST, ALT, ALP, GGT, LDH, bilirubin (direct and indirect) CA 19-9 levels and upper abdomen USG by means of choledochal dilatation and dilatation of intrahepatic bile duct in all cases before performing ERCP.The patients were divided into two groups as benign and malignant after ERCP. 35 of 52 cases were diagnosed as benign obstruction (1 case with oddi fibrosis,1 case with sclerosing cholangitis, 1 case with choledochal duplication and 32 cases with choledocholithiasis), and 17 of 52 cases were diagnosed as malignant obstruction (10 cases with malignant obstructions, 3 cases with cholangiocarcinoma and 4 cases with Klatskin tumour-adenocarcinoma).Mean serum CA 19-9 levels, mean leucocyte numbers, ESR , CRP, AST, ALT, ALP, GGT, LDH, bilirubine levels, choledochal dilatation and presence of dilatation in the intrahepatic bile ducti were all compared between two groups.Leucocyte numbers were significatly higher in the benign group (p=0,047). Mean ESR was significantly higher in the malignant group (p=0,047). CRP levels were significantly indifferent between both groups. Some of biochemical parameters, such as GGT and direct-indirect bilirubin levels, were significantly higher in the malignant group (p=0,014,p=0,0001 and p=0,012; respectively). The differences of AST, ALT, ALP and LDH levels between both groups were not statistically significant. Intrahepatic bile ducti and choledochal dilatations observed an USG were significantly higher in the malignant group when compared with the benign group (p=0,014).Mean serum CA 19-9 levels were observed as higher in the malignant group when compared with the benign group and this differance was statisticaly significant (p=0,0001); mean values were 118±170 (the highest value 289 U/L) and 670 ±406 in the benign and malignant groups, respectively. CA 19-9 was found >37 U/L in 54% of the benign group. CA 19-9 was found >37 U/L in all except 1 of the malignant group (94%).In conclusion , CA 19-9 which is a sensitive an spesific marker for pancreatico-biliary malignancies, may also be increased in benign bile ducti obstructive disease. Although it reaches higher serum levels in patients with malignancies, using this marker in cholestatic cases for diagnostic purpose may cause mistake evaluations, because high levels of this marker detected in benign diseases may be perplexity.