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 20 February 2018

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News

Novel markers determine the cause of obstructive cholestasis

This week's Annals of Internal Medicine investigates the diagnostic potential of serum and biliary markers in obstructive cholestasis.

News image

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Cholangiocarcinoma cells express and secrete insulin-like growth factor I and vascular endothelial growth factor.

Dr Domenico Alvaro and colleagues from Italy measured insulin-like growth factor-I and vascular endothelial growth factor in bile and serum of patients with extrahepatic cholangiocarcinoma to evaluate their performance as diagnostic markers.

Biliary insulin-like growth factor-I was 15- to 20-fold higher with extrahepatic cholangiocarcinoma
Annals of Internal Medicine

The team conducted a cross-sectional study with 73 inpatients who consecutively had endoscopic retrograde cholangiopancreatography (ERCP).

The team reported that 29 patients had extrahepatic cholangiocarcinoma, 19 had pancreatic cancer, and 25 had benign biliary abnormalities.

Diagnosis was based on conventional radiology, ERCP, and follow-up.

Insulin-like growth factor I and vascular endothelial growth factor were measured by using enzyme-linked immunosorbent assay.

The research team found that the biliary insulin-like growth factor-I concentration was 15- to 20-fold higher in extrahepatic cholangiocarcinoma than in pancreatic cancer.

The biliary insulin-like growth factor-I concentration was also 15- to 20-fold higher in extra hepatic cholangiocarcinoma than in benign biliary abnormalities.

The area under the receiver-operating characteristic curve was 1 when biliary insulin-like growth factor-I values in the extrahepatic cholangiocarcinoma were compared with benign biliary abnormalities or pancreatic cancer.

The researchers found that, in contrast, biliary vascular endothelial growth factor concentration was similar in the 3 groups.

Serum insulin-like growth factor-I levels were similar among the groups.

The team observed that serum vascular endothelial growth factor levels were higher in the cholangiocarcinoma, and pancreatic cancer groups.

The team noted limitations of the study, reporting that data were obtained in a small sample from a single center, and few patients had a tissue diagnosis.

Dr Alvaro's team concluded, "Biliary insulin-like growth factor-I levels in patients undergoing ERCP for biliary obstruction may differentiate extrahepatic cholangiocarcinoma from either pancreatic cancer or benign biliary abnormalities."

Ann Int Med 2007: 147(7): 451-9
09 October 2007

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