Value of gastric juice carcinoembryonic antigen in identifying high-risk patients for gastric cancer.

The relationship of the level of carcinoembryonic antigen (CEA) in the gastric juice to the extent of intestinal metaplasia and gastric cancer, and clinical values of gastric CEA for identifying high-risk patients for gastric cancer were examined. A significant correlation was found between the levels of gastric CEA and the distribution of intestinal metaplasia. Studies were made by the endoscopic Congo red-methylene blue test developed at our hospital. Gastric CEA levels were significantly higher in patients with localized and diffuse intestinal metaplasia than in those with no intestinal metaplasia. The mean levels of gastric CEA in patients with well-differentiated adenocarcinomas were significantly higher than in those with diffuse intestinal metaplasia. They were also significantly higher in patients with poorly differentiated adenocarcinomas than in patients with no intestinal metaplasia, but not significantly higher than in those with diffuse intestinal metaplasia. Endoscopic follow-up examinations show that gastric cancer was detected in only 1 patient with a gastric CEA level of 10 ng/ml or more, but in none of those with gastric CEA of less than 10 ng/ml, during the average observation period of 4.3 years. These results indicate that gastric CEA is produced both by intestinal metaplasia and well- and poorly differentiated adenocarcinomas, and that gastric CEA is useful in identifying high-risk patients for gastric cancer.