Cholangi̇ti̇s statement comes wi̇th i̇ndetermi̇ne bi̇le duct stri̇cture di̇fferenti̇al di̇agnosis of pati̇ents with prognosti̇c value of gall CA19-9 and CEA level

Background and purpose: cholangitis, a disease characterized by inflammation and infection of the biliary tract. It is a manifestation characterized by bacterial growth and biliary obstruction signs. Its etiology includes choledocholithiasis, biliar stricture and primary sclerosing cholangitis. Clinicals findings for the diagnosis are biliary tract disease, fever and/or chills, jaundice, right upper quadrant pain whereas laboratory findings are leukocytosis, CRP elevation, abnormal transaminase levels and imaging findings are identified as common bile duct and/or dilatation in intrahepatic bile ducts.In this study, we aimed to assess the CEA and CA 19-9 levels on biliary stricture patients with cholangitis during active disease and recovery period and in-vestigate the availability of bening and malignant etiology distinction. Material-methods: The study included 34 hospitalized patients with a diagnosis of cholangitis at Sakarya University Training and Research Hospital. ERCP was performed and bile samples were taken in accordance with nasobiliary drainage catheter insertion and bile CEA and CA 19-9 levels were measured. Same examination of bile were performed through existing catheter at the end of 48 hours passed without fever. Changes in these levels-if any- were evaluated with patients final diagnoses (malign biliary stricture-benign biliary stricture) in their file. Results: A total number fo 34 patients including 21 with benign and 13 with malignant were included in this study. During pre and post treatment period, serum CEA and serum CA 19-9 levels of malignant group was significantly higher than benign group. (respectively (p=0.004, p= 0.007), (p=0.014, p=0.007)). Bile CEA and biliary CA 19-9 levels did not show a significant difference between benign and malignant group of patients during pre and post treatment period (respectively (p=0.651, p=0.313) (p=0.764, p=0.721)). In benign group of patients, while serum CEA and bile CA 19-9 levels did not vary statistically significant (p = 0.481, p = 0.505), bile CEA and serum CA 19-9 levels showed a statistically significant reduction (p = 0.006, p = 0.010) after treatment. In malignant patients, serum CEA level, bile CEA level, serum CA 19-9 level, biliary CA 19-9 levels did not show a statistically significant change (respectively p = 0.313 and p = 0.310, p = 0.465, p = 0.917) after treatment. DISCUSSION: Cholangiocellular cancer should be eliminated first in biliary stricture etiology. In this diagnosis, serum or bile CEA and CA 19-9 levels, sensitivity and specificity are markers of variability. Our study concludes that detected dropping levels of bile CEA and serum CA 19-9 could be used to distinguish benign and malignant etiology of biliary strictures. Key words: CEA, CA 19-9, cholanjitis, bile