Duodenal Carcinoembryonic Antigen in Patients With Benign and Malignant Diseases: Preliminary Observations23

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Abstract
Carcinoembryonic antigen (CEA) in duodenal juice was measured to assess whether 1) we can indirectly detect increased production of CEA in tumor patients after determining normal hepatobiliary CEA excretion and 2) this assay can help to distinguish between elevated plasma CEA levels due to benign liver disease and those due to other conditions, especially cancer or benign gastrointestinal inflammatory disease. Duodenal aspirates were collected from 41 patients for 20 minutes before and for six 10-minute and one final 20-minute period following iv administration of 1 U secretin/kg. The most diagnostically discriminant results were obtained with the use of duodenal CEA outputs for the entire 100-minute collection. All 7 control patients had duodenal CEA outputs of less than 150 ng/minute. Of the 11 patients with CEA-associated cancers, 10 had duodenal outputs greater than 150 ng/minute. The one exception had a plasma CEA level of only 1.9 ng/ml. Four of 6 patients with colon cancers or colorectal polyps and normal plasma CEA levels had increased duodenal CEA outputs. Five of 6 patients with benign liver disease or extrahepatic biliary obstruction and elevated circulating levels had normal duodenal CEA outputs. The coefficient of correlation of CEA and bilirubin contents of serial samples of duodenal aspirates was positive in 38 of 41 instances. These data show that duodenal CEA is partially of hepatobiliary origin and suggest that it is potentially clinically useful in distinguishing between increased circulating CEA resulting from impaired metabolism and/or excretion due to liver disease and increased levels due to augmented production from any cause, especially cancer. It may detect increased production while plasma levels are still normal. Further study is needed, however, before such analysis can be recommended as a practical clinical tool.