WCIM 2014 SEOUL KOREA 571
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0980 Pancreatobiliary
Study of an Elevated Carbohydrate Antigen 19-9 in Asymptomatic Patients
Se Hoon Sohn1, Kyeong Ok Kim1, Kook Hyun Kim1, Si Hyung Lee1, Byung Ik Jang1, Tae Nyeun Kim1
Yeungnam University Mecical Center, Korea1
Background: CA19-9 has been established as a useful tumor marker for gastrointes- tinal cancer. However interpretation of elevated CA19-9 is diffi cult because it could be also noted in many benign diseases. We aimed to evaluate the etiology and clinical outcome of elevated CA19-9 levels in asymptomatic subjects.
Methods: From January 2004 to December 2013, total 734 subjects with elevated CA19-9 level (>37 U/mL) from 63867 subjects, who underwent an examination at the health promotion center in our institution were analyzed retrospectively.
Results: Mean age of the patients was 50.62 (±13.27) years and male to female ratio was 1:1.3. Mean level of CA 19-9 was 155.33 (±1624.54) U/ml. Malignancy was de- tected in 36 cases (4.9%). There were 9 cases of pancreatic cancer, 9 cases of hapato- biliary cancer and 13 cases of other gastrointestinal cancer. Benign diseases included 56 cases of gallbladder or biliary stone, 32 cases of GB polyp and 17 cases of hypo- thyroidism. The mean CA19-9 level of patients with cancer was 717 (±1449) U/mL and 126.3 (±1629) U/ml for other cases. Factors related to cancer were age above 65 and increased ALP level above 270 IU/L. In 455 subjects (60.6%), the etiology could not be confi rmed and among them, 128 subjects could be followed up. Among subjects who were followed up, 55.5% subjects showed increased CA 19-9 level continuously while the other 44.5% subjects showed normalization.
Conclusions: Our result showed that 698 (95.1%) asymptomatic subjects with in- crease CA 19-9 were not associated with malignancy and 455 (65.2%) of them were with unknown cause. Normalization was noted in 44.5% of the unknown cause. In- creased ALP level and older age were related to malignancy and we need to evaluate more meticulously to fi nd out hidden malignancy in subjects with these factors.
PS 0981 Pancreatobiliary
Feasibility of Self-Expandable Metal Stent for Removal of Stones in Patients with Small Caliber Common Bile Duct: A Pilot Study
Chung Hwan Jun1, Chang Hwan Park1, Sung Uk Lim1, Seon Young Park1, Wan Sik Lee1, Young Eun Joo1, Hyun Soo Kim1, Sung Kyu Choi1, Jong Sun Rew1
Chonnam National University Hospital, Korea1
Background/Aims: Recently, biliary self-expandable metal stents (SEMS) have been employed successfully in the treatment of diffi cult common bile duct (CBD) stones.
However, there is no data about removal of CBD stones using SEMS without endo- scopic sphincterotomy (EST) to preserve sphincteric function of ampulla of Vater. The aims of study were to evaluate the SEMS for removal of stones in patients with small caliber CBD and for preservation of sphincter function.
Methods: A SEMS was used to dilate the major papilla to allow lithotripsy and re- moval of small caliber bile duct stones in 10 patients between February 2014 and July 2014.
Results: Mean age was 47.3 years (range, 23-75); the mean diameter of CBD was 8.8 mm (range, 5-10 mm); the mean diameter of stones was 5.6 mm (range, 3-8 mm);
the mean number of stones was 1.5 (range, 1-4). In 9 (90%) patients, stones were removed using basket without mechanical lithotripsy; in 1 (10%) patient, stone was removed using mechanical lithotripsy. All stents were removed successfully using rat tooth. All patients have preserved sphincter of Oddi function. There were no signifi cant complication related the procedure.
Conclusions: Trans-papillary SEMS facilitates bile duct stones removal in patients with small caliber bile duct. And this technique appears to be effective in preservation of sphincter of Oddi function
PS 0982 Pancreatobiliary
Diagnostic Value of Eus in Symptomatic Patients with High and Intermediate Probability for Common Bile Duct Stones, but a Negative Ct Scan
Hee Woo LEE1, Ji Young PARK2, Jeon Tae JOO2, Yeon Suk KIM1, Jae Hee CHO1 Gachon University Gil Hospital, Korea1, Inje University College of Medicine, Sanggye Paik Hospital, Korea2 Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard method for diagnosis and treatment of common bile duct (CBD) stones, however has a significant procedure related complications. Endoscopic ultrasonography (EUS) is a minimally invasive technique with low morbidity and proven effi cacy in the diagnosis of choledocholithiasis. We aimed to investigate the usefulness of EUS in patients with clini- cally suspected CBD stones of high and intermediate probability but a negative CT scan.
Methods: Between March 2008 and April 2014, 165 patients with CT negative clini- cally suspected CBD stones with high and intermediate probability were evaluated. All patients underwent EUS and then choledocholithiasis was confi rmed by ERCP.
Results: ERCP revealed CBD stones in 135 (82%) of 165 CT scan negative patients. On EUS examination, CBD stones were found in 136 patients and size was 4.4 ± 0.2mm (mean ± SD). EUS accuracy for choledocholithiasis was 95% (sensitivity 98%, specifi c- ity 80%, positive predictive value 96%, negative predictive value 89%). On the multi- variate analysis, the presence of CBD stones on EUS (OR 1438, CI 78-26530), age>55 (OR 11, CI 1.1-114), bilirubin>4(OR 35, CI 2.0-611) and clinical diagnosis of cholangitis (OR 209, CI 8.5-5190) were strong predictive factors for choledocholithiasis. However, CBD dilation, pancreatitis, Liver function tests abnormality, ASGE probabilitywere not statistically signifi cant. In addition, there are 21 cases of ERCP related complication in- cluding 14 (8.4%) mild post-ERCP pancreatitis, 7 (4.2%) minor bleeding, and one (0.6%) infundibulotomy related perforation.
Conclusions: EUS fi nding of CBD stone, cholangitis, old age and hyperbilirubinemia are strong predictors for choledocholithiasis in suspected symptomatic patients with a negative CT scan. Therefore, EUS-fi rst approach is recommended in high and interme- diate probability of CBD stones and it can reduce the unnecessary ERCP.
