Although carbohydrate antigen 19-9 (CA 19-9) may be elevated in benign diseases, elevated CA 19-9 may cause a fear of cancer and unnecessary follow-up studies. Research on how to approach systematically in this case is very limited. The purpose of this study was to analyze the clinical features and the causes of CA 19-9 elevation without evidence of malignant or pancreatobiliary diseases. We retrospectively reviewed the medical records of patients who had CA 19-9 elevation (≥80 U/mL) and were found to be unrelated to cancer after follow-up. After exclusion, 192 patients were included in this study. The median level of CA 19-9 was 136.5 U/mL. The causes of CA 19-9 elevation were determined in 147 (76.6%) patients, and that was unknown in 45 (23.4%). The estimated causative diseases were hepatic diseases in 63 patients, pulmonary diseases in 32, gynecologic diseases in 38, endocrine diseases in 13, and spleen disease in 1. Of 45 patients with unknown cause, 35 had normalization of CA 19-9 and 10 had persistently elevated CA 19-9. In conclusion, CA 19-9 elevation without malignancies or pancreatobiliary diseases should be systematically evaluated and followed up. We suggest an algorithm to investigate the causes and follow up these patients. Tumor markers are useful for screening and diagnosis of cancer in high-risk patients, evaluating the response to cancer treatment and detecting the recurrence of cancer. As health checkups are becoming widely available, tumor markers are being checked in asymptomatic healthy people for screening purposes. Among the many tumor markers, carbohydrate antigen 19-9 (CA 19-9) has a relatively high sensitivity and specificity for pancreatic and biliary tract tumors 1,2. According to previous studies, the sensitivity of CA 19-9 in diagnosing pancreatic cancer ranges between 79% and 95%, and the specificity ranges between 82% and 91% 3,4. CA 19-9 has its diagnostic value when the patient has symptoms such as weight loss, abdominal pain, and jaundice or when imaging studies indicate a tumor. However, in asymptomatic patients, there is little evidence of its clinical value in screening for cancer 5-8. In a study conducted with 70,940 asymptomatic individuals, the positive predictive value of CA 19-9 was only 0.9% including ineffectiveness in screening for pancreatic cancer 8. CA 19-9 is synthesized in the normal pancreatic parenchyma and biliary tract. It is also produced from the epithelial cells of the gastric, colonic, and uterine mucosa, as well as the salivary glands 9. From a malignant tumor perspective, CA 19-9 has been reported to be increased in stomach, colorectal, lung, thyroid, as well as biliary and pancreatic cancer 10. CA 19-9 is often elevated in benign pancreatobiliary diseases such as cholangitis, obstructive jaundice and pancreatitis 11,12. Additionally, it has been reported that elevated CA 19-9 levels can be found in other non-malignant conditions such as pulmonary and thyroidal diseases, diabetes mellitus, and gynecologic diseases 5,13,14. In patients with an elevated...

Regular follow-up is not routinely recommended for patients with first-time endoscopic stone removal, but is recommended for patients with recurrent stones. Cholecystectomy is recommended for patients with GB stones who are younger than 70 years.

Very few population-based studies have examined the epidemiology of Wilson's disease (WD). We investigated the epidemiology of WD using the national Health insurance Service (nHiS) database in South Korea. We analyzed not only the statistical variables of WD, but also those of WD-related diseases. WD patients were identified with the relevant International Classification of Diseases-10 code out of 50.5 million people. We used the NHIS database from 2009 to 2016 and analyzed the incidence rate, prevalence, and clinical symptoms of WD. A total of 1,333 patients were identified. The average annual incidence rate was 3.8 per million person-years. The prevalence was 38.7 per million people. The mean diagnostic age was 26.1 ± 17.2 with earlier diagnosis in men (P = 0.0003). Among the patients, 988 (74.1%) had hepatic symptoms, 510 (38.3%) had neurologic symptoms, and 601 (45.1%) had psychiatric symptoms. Before the diagnosis of WD, 350 (26.3%) had neurologic symptoms, and 427 (32%) had psychiatric symptoms. The annual mortality rate was 0.7%. Age, liver cirrhosis, and liver failure correlated with a fatal prognosis (P < 0.05). Many patients showed neurologic and psychiatric symptoms before they were diagnosed with WD. prognosis correlated with age, liver cirrhosis, and liver failure. Wilson's disease (WD) is an autosomal-recessive disorder associated with copper metabolism that produces abnormal accumulation of copper in the liver, brain, kidneys, and other organs 1. It is caused by mutations in the ATP7B gene, which is involved in transporting copper across cell membranes 2,3. Genetic variation among mutations leads to a broad spectrum of clinical manifestations, including hepatic, neurologic, and psychiatric symptoms 4. Generally, patients are diagnosed with WD after experiencing hepatic symptoms. When patients present without specific symptoms or the initial symptoms are neurologic or psychiatric, the diagnosis of WD can be delayed. However, neuropsychiatric symptoms are pretty common, occurring in about a third of WD patients 5. Studies have reported that neurologic and psychiatric manifestations are present in up to 40% and 10-25% of patients respectively, at the time they are diagnosed with WD 6,7. Thus, research into neuropsychiatric aspects of WD is currently receiving attention. Most patients with WD are diagnosed before they are 40 years old, although WD has been reported at ages from 2 to 80 years 8-10. In the past, the incidence rate of WD was reported to be 30 per million person-years 1. But a recent study in Hong Kong reported an average annual incidence rate of 1.44 per million person-years, and a recent study in France found a prevalence of 15 per million person-years 11,12. Only a few epidemiological studies about WD have been carried out, and most of them are more than 30 years old. Changes in the diagnostic criteria, including gene analysis and quantitative serologic study, enabled by the progression of diagnostic technology have created a need for new epidemiological studies of WD.