EFFECT OF ENDOSCOPIC SPHINCTEROTOMY AND OR SPHINCTEROPLASTY DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) ON THE LEVELS OF CA19-9

Abstract

Background: Increased levels of CA19-9 are not only seen in malignant biliary tract diseases but in benign diseases also. It becomes very difficult to differentiate between malignant and benign biliary disorders purely on the basis of CA19-9 levels and is possible only if there are associated clinical or other features suggestive of malignancy. The CA 19-9 tends to normalize following the restoration of biliary drainage with the help of ERCP (Endoscopic Retrograde Cholangiopancreatography) .

Objectives: This study was undertaken to see the effect of sphincterotomy/ sphincteroplasty during Endoscopic Retrograde Cholangiopancreatography (ERCP) to relieve the biliary obstruction, on the serum levels of CA19-9 and determine any relationship between the change in the levels of CA19-9 with the cause of obstruction, whether benign or malignant, following drainage procedure.

Study Design: Prospective observational hospital based study

Materials & Methods: A total of 200 patients who underwent either sphincterotomy and or sphincteroplasty during Endoscopic Retrograde Cholangiopancreatography (ERCP) were included in the study. Patients who had already undergone sphincterotomy and or sphincteroplasty were excluded from the study. CA19-9 level estimation was done before and within 72 hrs of ERCP.

Results: In our study we found that fall in serum levels of CA19-9 in benign group (64.8%) following biliary drainage was more than the rise and no change; and this fall in CA19-9 level in benign group was more than that in the malignant group (53.7%) . The serum level of CA19-9 in many patients with pancreaticobiliary cancer did not change or decrease much. In contrast, most cases of benign disease showed fall in CA19-9, though there was an increase in CA19-9 levels in around 22.6% and no change in 12.6%.

Conclusion: Fall and rise in the levels of CA19-9 within 72 hours of relieving the biliary obstruction can’t differentiate between malignant and benign biliary obstruction. However, no change in the levels of CA19-9 following adequate biliary drainage may suggest malignant biliary obstruction.