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Markedly elevated serum CA 19-9 levels in association with a benign biliary stricture due to primary sclerosing

Mark D Murray1, Frank R Burton, Adrian M Di Bisceglie

  • 1Division of Gastroenterology and Hepatology, Saint Louis University Liver Center, Saint Louis University School of Medicine, St Louis, MO 63110, USA.

Journal of Clinical Gastroenterology
|January 2, 2007
PubMed

Insights

In patients with ulcerative colitis and biliary obstruction, CA 19-9 levels can be falsely elevated. Measuring CA 19-9 after relieving biliary obstruction provides a more accurate assessment, avoiding misdiagnosis of cholangiocarcinoma.

Area of Science:

  • Gastroenterology and Hepatology
  • Oncology

Background:

  • Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
  • Primary sclerosing cholangitis (PSC) is a serious complication of UC.
  • Cholangiocarcinoma (CCA) is a malignancy of the bile ducts.

Observation:

  • A 55-year-old man with long-standing UC presented with jaundice.
  • He was diagnosed with PSC, complicated by a dominant common bile duct stricture.
  • Serum CA 19-9 was markedly elevated at 26,321 U/mL.

Findings:

  • Following successful stenting of the bile duct stricture, CA 19-9 levels promptly normalized.
  • Long-term follow-up revealed no evidence of cholangiocarcinoma.
  • This suggests that benign biliary strictures can cause falsely elevated CA 19-9 levels.

Implications:

  • Serum CA 19-9 levels must be interpreted within the clinical context of biliary obstruction.
  • Measurement of CA 19-9 after relief of obstruction is crucial for accurate diagnosis.
  • This case highlights the importance of considering benign etiologies for elevated CA 19-9 to prevent misdiagnosis of cholangiocarcinoma in UC patients with PSC.

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