Significance of isolated gastric varices among Chinese patients.

BACKGROUND: Isolated gastric varices rarely occurs, and was considered as a hint of pancreatic disease rather than liver cirrhosis. Recently, the frequency of acute gastrointestinal bleeding secondary to isolated gastric varices tended to increase among cirrhotic patients. We therefore conducted this retrospective study to analyze its possible etiologies. METHODS: Thirty-six cases of isolated gastric varices were found in an extensive review of the endoscopic records at our hospital from 1984 to 1993. Gastric varices developed after injection sclerotherapy of esophageal varices were excluded. Medical records were reviewed to determine their etiologies. RESULTS: The underlying disorders of these 36 patients included liver cirrhosis in 26 patients (72.2%), pancreatic diseases in 7 patients (19.4%), myelofibrosis in 1 patient (2.7%), and unknown cause in 2 patients (5.5%). Among those with liver cirrhosis, portal hemodynamic study conducted in 5 patients to find all with a high level of portal venous pressure; angiography conducted in 5 patients also found all with gastric varices. Among those with pancreatic diseases, angiography and/or splenoportography was conducted in 5 patients to evidence all with gastric varices, splenic vein obstruction and splenomegaly. CONCLUSIONS: Isolated gastric varices identified in endoscopy can first strongly suggests the presence of liver cirrhosis with portal hypertension. Pancreatic diseases complicating with splenic vein obstruction is the second possible underlying etiology.

Clinical values of CA19-9, CA125 and CEA in malignant obstructive jaundice.

BACKGROUND: Serum CA19-9, CA125 and CEA are glycoproteic tumor markers and they have been used for detecting patients with pancreatobiliary diseases in whom obstructive jaundice is common. This study was designed to investigate whether cholestasis may interfere with the clinical application of these tumor markers or not. METHODS: Radioimmunoassay for serum CA19-9, CA125 and carcinoembryonic antigen (CEA) was obtained from 86 patients with hyperbilirubinemia, including 50 patients with malignant jaundice (pancreatic carcinoma 20, biliary tract carcinoma 30) and 36 patients with benign jaundice (choledocholithiasis 33, acute cholangitis 3). Clinical follow-up for the utility of these markers on the patients with obstructive jaundice was conducted. RESULTS: In patients with malignant jaundice, higher positive rates of CA19-9 (94% vs 56%, p < 0.01), CA125 (52% vs 17%, p < 0.01) and CEA (42% vs 6%, p < 0.01) than in those with benign jaundice were found. In diagnosis of malignant tumors, sensitivity was superior in CA19-9 (94%) than in CA125 (52%) and CEA (42%), but the latter two had higher specificities (83% and 95%). In malignant jaundice, elevated serum bilirubin levels were correlated with CA125 (r = 0.34, p < 0.05) but not with CA19-9 levels. In benign jaundice, serum bilirubin were correlated with CA19-9 (r = 0.58, p < 0.001) and CA125 (r = 0.45, p < 0.01) levels. The correlation between serum bilirubin and CEA levels was not significant in either group. After effective drainage, all markers decreased significantly in patients with benign jaundice but not in those with malignant diseases. CONCLUSIONS: Elevated serum CA19-9, CA125 and CEA levels were observed in both benign and malignant pancreatobiliary diseases with obstructive jaundice. Longitudinal follow-up of these markers and other complementary studies are essential for diagnosis of malignant tumors when cholestasis is present.

Intraductal mucin-hypersecreting papillary adenocarcinoma of the pancreas: a case report.

A 68-year-old male was admitted with jaundice and abdominal fullness. Abdominal ultrasonography and computed tomography (CT) scan showed a diffusely dilated main pancreatic duct (MPD) with microcystic lesions over the pancreatic head and dilatation of the biliary tract. Duodenoscopy revealed mucin secretion at the orifice of the papilla of Vater. Findings of endoscopic retrograde cholangiopancreatography (ERCP) were compatible with a mucinous tumor of pancreas invading the common bile duct. The patient was treated with a modified Whipple's operation. Pathological diagnosis was papillomatosis with papillary adenocarcinoma of the pancreas.