Role Of Pre-Operative Upper Gastro-Intestinal Endoscopy In Symptomatic Patients Undergoing Elective Laparoscopic Cholecystectomy For Gall Bladder Stone Disease:A One Year Hospital Based Cross-Sectional Study

Abstract

INTRODUCTION: Cholelithiasis. is .one .of. the most. common. problem encountered .in .surgery1. The diagnosis of cholelithiasis has. steadily increased because of the common access to ultrasound examination. The vast. majority of cholecystectomies. are performed for gallstone disease .with cholesterol gallstones accounting for nearly. 75% of all gallstones2. A proportion of patients do not get symptomatic relief after cholecystectomy for gallstone disease3. As their symptoms are not entirely due to cholelithiasis they unnecessarily undergo the risks associated with laparoscopic cholecystectomy. The ultrasound finding of gallstones may be incidental and peptic ulcer disease of the stomach or the duodenum, gastro-oesophageal reflux or hiatus hernia may be the true cause of pain. Symptomatology of upper GI diseases can be overlapping. Upper abdominal pain may be secondary to either cholelithiasis or gastro duodenal diseases. Differentiating between these two situations is important, because the prevalence of both conditions is common in the general population. Thus, this study tries to seek the importance of upper gastro intestinal endoscopy to reveal the association between gastrointestinal symptoms and diseases with gallstones. OBJECTIVE: To assess the value of preoperative upper GI endoscopy for qualifying patients with Gall bladder(GB) stone disease undergoing elective laparoscopic cholecystectomy, by determining presence of upper GI lesions. MATERIALS AND METHODS: This is a prospective study conducted on 66 cases of ultrasound proven gallstone disease, at the department of general surgery, Dr. Prabhakar Kore Hospital and Medical Research Center irrespective of age and sex. After examination all the patients were subjected to Upper GI endoscopy. The statistical analysis was conducted using SPSS version 22. RESULTS: Out of 66 study sample, 57.6 % (n=38) were female and 42.4 % (n=28) were males with the mean age of 45.8 years. Symptomatology has shown atypical biliary colic accounting for 54.5% (n=36) in comparison to typical biliary colic of 45.5% (n=30). All subjects were subjected for upper GI endoscopy which detected a total number of 24 samples having positive upper GI lesions accounting for 36.4% (n=24), which is statistically significant (p=0.045) and 63.6 % (n=42) being normal on endoscopy. Among the 66 study subjects 36.4% (n=24), were found to have positive UGI scopy findings, out of which 29.2% (n=7) had typical biliary colic and 70.8% (n=17) had atypical biliary symptoms. In comparison with this 63.6% (n=42) of the study subjects had normal UGI scopy findings, out of which 54.8% (n=23) had typical biliary colic and 45.2% (n=19) had atypical biliary colic. Inferring that the chances of yielding a positive UGI scopy is higher in patients with atypical biliary symptoms. CONCLUSION: The increased access to ultrasound for patients presenting with pain abdomen, has led to an increase in the diagnosis of cholelithiasis, as its symptomatology overlaps many upper GI lesions, the incidental finding of gall stones on ultrasound may mask the co-existing UGI lesions. In this study UGI lesions were found in 36.4% of the patients. Hence treating either one of them only will lead to persistence of symptoms post treatment. Thus we recommend an UGI-SCOPY pre-operatively for patients undergoing elective laparoscopic cholecystectomy for gallbladder stone disease for adequate diagnosis and treatment of the co-existing UGI lesions if present and reduce the incidence of post operative persistence of symptoms.