Value of serum CA 19-9 in obstructive jaundice

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Abstract

Background

CA 19-9 was found to be elevated in a variety of malignant and benign conditions of the pancreas, colorectum, lung, liver, and ovary. Hence, changes in CA 19-9 levels before and after biliary drainage should be carefully monitored in patients with obstructive jaundice.

Aim

The aim of this work was to study the role of CA 19-9 in accurately differentiating between benign and malignant obstructive jaundice.

Patients and methods

The study was conducted at the Gastrointestinal Endoscopy Unit of Theodour Bilharz Research Institute on 60 patients presenting to the endoscopic retrograde cholangiopancreatography unit with obstructive jaundice. Patients were divided into two groups. Group 1 included patients with calcular obstructive jaundice, whereas group 2 included patients with malignant obstructive jaundice. Assessment of CA 19-9 at the time of diagnosis and after relief of obstruction was carried out.

Results

Results showed a significant reduction in CA 19-9 following drainage of calcular obstructive jaundice, as well as a nonsignificant reduction in CA 19-9 following management of malignant obstructive jaundice. Malignancy is suggested by a serum CA 19-9 cutoff value of more than 40.5 IU/ml with 80% sensitivity, 90% specificity, 88.9% positive predictive value, 81.8% negative predictive value, and 85% accuracy.

Conclusion

A nonsignificant decrease in CA 19-9 following biliary drainage in cases of obstructive jaundice suggests malignancy. Malignant obstructive jaundice could be predicted at CA 19-9 cutoff value above 40.5 IU/ml.

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