Abstract
Background: Symptomatic cholelithiasis and upper gastrointestinal inflammatory pathologies are common causes of upper abdominal pain. It is often difficult to differentiate gastrointestinal symptoms due to gall stones from those due to pathologies in the upper GI tract.
Aim: The objective of the study was to analyze the role of upper gastrointestinal endoscopy in cholelithiasis patients with typical biliary colic or atypical upper abdominal symptoms undergoing elective cholecystectomy.
Methods: This prospective observational study was conducted on 163 patients in Tagore Medical College and Hospital from January 2017 to December 2018. We analyzed personal information, presenting symptoms & investigations including USG, pre operative UGI endoscopy, biopsy reports if present, medications, surgery details,& post operative complications (if any) for all the patients included in the study.
Results: A total of 163 patients were included in the study. Mean age of presentation was
41.33 years. The ratio of female to male is 2.4:1. Upper GI endoscopy revealed different abnormal pathologies in (n=80) 49% of the patients in both symptom groups of the patients. Gastritis (14.7%) was the most common abnormal UGI endoscopy finding in this study. Performing a preoperative UGI endoscopy has an important role in identifying other causes of upper abdominal pain that coexist with cholelithiasis.
Conclusions: Upper Gastrointestinal endoscopy should be performed preoperatively for all cholelithiasis patients who present with either classical biliary colic or atypical upper abdominal pain when planning for elective laparoscopic cholecystectomy to evaluate for associated upper gastro intestinal diseases, thereby helping in a better therapeutic outcome.
Keywords: Cholelithiasis, Endoscopy, Cholecystectomy, Post Cholecystectomy syndrome.
References
- Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7:132–140
- Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007;52:1313–1325
- Ransohoff DF, Gracie WA, Wolfenson LB, Neuhauser D. Prophylactic cholecystectomy or expectant management for silent gallstones. A decision analysis to assess survival. Ann Intern Med. 1983;99:199–204
- Kratzer W, Mason RA, Kächele V. Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound. 1999;27:1–7.
- Basselink MGM, Erpecum KJ. Biliary Colic is a valuable clinical descriptor for Biliary pain due to “uncomplicated” gallstone disease. J Gastrointest Sung. 2009;13(9):1745-6.
- Kraag N, Thijs C, Knipschild P. Dyspepsia-how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance. Scand J Gastroenterol. 1995;30(5):411-21.
- Berger MY, Hartman TC, Vander VJJM, Bohnen A. Is biliary pain exclusively related to gall bladder stone.? A controlled prospective study. Br J Gen Pract. 2004;54(303):574-9.
- Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005;15(3):329-38.
- Conte D, Fraquelli M, Giunta M, Conti CB. Gall stones and Liver disease; an overview. J Gastrointestin Liver Dis. 2011;20:9-11.
- Girometti R, Brondani G, Cereser L, Como G, Del Pin M, Bazzocchi M, Zuiani C. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. British J Radiol. 2010;83(988):351-61.
- ASGE Guidelines. Patient preparation for gastrointestinal endoscopy. Gastrointest Endosc. 1998;48(6):691-694.
- Oddsdottir M, Hunter JG. Gallbladder and the extra-hepatic biliary system. In F. Charles Brunicard Schwartz's Principles of surgery 8th Ed. McGraw-Hill. New Delhi; 2005:1190-1095.
- Khalili TM, Phillips EH, Berci G, Carroll BJ, Gabbay J, Hiatt JR. Final score in laparoscopic cholecystectomy. Surg Endosc. 1997;11(11):1095-8.
- Friedman GD. Natural history of asymptomatic and symptomatic gallstones. American Journal of Surg. 1993;165:399-404.
- McSherry CK. Cholecystectomy-the gold standard. Am J Surg. 1989;158:174-8.
- Thybusch A, Schaube H, Schweizer E, Gollnick D, Grimm H. Significant value and therapeutic implications of routine gastroscopy before cholecystectomy. J Chir. 1996;13(4):171-4.
- Luman W, Adams WH, Nixon SJ, Mcintyre IM,Hamer-Hodges D, Wilson G et al. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut.1996;39:863-6.
- Järhult J. Is preoperative evaluation of the biliary tree necessary in uncomplicated gallstone disease? Results of a randomized trial. Scand J Surg. 2005; 94:31-33.
Corresponding Author
Prasanna. C.M
Assistant Professor, Department of General Surgery, Tagore Medical College and Hospital, Rathinamangalam, Tamilnadu, India
Mobile: +91 98842 16792, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.