DOI: http://dx.doi.org/10.18203/2349-2902.isj20192222

Gall stones and dyspepsia: does upper gastrointestinal endoscopy have a pivotal role?

Harsha Narayan, Nagaraj Ravishankar, Shivakumar Shivabasappa, Nalini Kotekar

Abstract


Background: Asymptomatic gallbladder stones are often diagnosed as an incidental finding. Gallstone disease is asymptomatic in most patients diagnosed to have gall stone and cholecystectomy is considered to be the treatment of choice. However, less focus has been given to patient selection and to the symptoms of this disease in order to understand prevailing symptoms after surgery. Studies suggest that approximately 25% of patients undergoing cholecystectomy will not experience relief of symptoms, and that dyspeptic symptoms are least likely to be cured by cholecystectomy. Post-cholecystectomy syndrome (PCS) consists of a group of symptoms that persist after cholecystectomy. It is defined as early if occurring in the post-operative period and late if it manifests after months or years. The objectives of the study were to emphasize the importance of endoscopic evaluation as a routine pre-operative investigative tool in patients with dyspepsia and gall stones and evaluate the prevalence of dyspeptic symptoms in patients with gall stone disease.

Methods: 92 patients with USG proven gall stones presenting with dyspepsia attending OPD or admitted in surgery department (JSS Hospital) were studied. Upper GI endoscopy was performed to detect for significant lesions.

Results: Most common endoscopic finding was gastritis. Malignancy was found in 3 (3.3%) patients. The management plan was changed for 9 (13.6%) patients.

Conclusions: Significant endoscopic findings were observed in 72.8% of patients. Routine pre-operative upper GI endoscopy is recommended in all patients with gall-stone disease who present with dyspepsia to avoid unnecessary cholecystectomy.


Keywords


Cholecystectomy, Upper GI endoscopy, Gall stones, Dyspepsia, Post-cholecystectomy syndrome

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References


Girometti R, Brondani G, Cereser L, Como G, Del Pin M, Bazzocchi M, et al. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. Br J Radiol. 2010;83(988):351-61.

Huang J, Chang CH, Wang JI, Kuo HK, Zin JW, Shan WY. Nationwide epidemiological study of several gallstone disease in Taiwan. BMC Gastroenterol. 2009;9:63.

Sosada K, Zurawinski W, Piecuch J, Stepien T, Makarska J. Gastroduodenoscopy: A routine examination of 2,800 patients before laparoscopic cholecystectomy. Surg Endosc. 2005;19 (5):1103-8.

Gaharwar A. Factors favouring cholelithiasis in North Indian population. IOSR J Pharmacy. 2013;3(5):01-3.

Mozafar M, Sobhiyeh MR, Heibatollahi M. Is esophagogastroduodenoscopy essential prior to the elective surgical therapy of symptomatic cholelithaisis? Gastroenterol Hepatol. 2010;3(2):77-82.

Ure BM, Spangenberger W, Lefering R, Dietrich A, Troidl H. Routine gastroscopy before laparoscopic cholecystectomy: evaluation of the technology in 376 patients. Z Gastroenterol. 1992;30(3):529-33.

Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms, do they disappear after cholecystectomy? A systematic literature review and a controlled prospective study. Surg Endosc. 2003;17(11):1723-8.

Rashid F, Rashid N, Waraich N, Ahmed J, Iftikhar SY. Role of routine oesophagogastroduodenoscopy before cholecystectomy. Int J Surg. 2010;8 (4):236–8.

Schwenk W, Böhm B, Badke A, Zarras K, Stock W. Preoperative esophagogastroduodenoscopy before elective surgical therapy of symptomatic cholelithiasis. Leber Magen Darm. 1992;22 (6):225- 9.

Diettrich H, Wündrich B, Kobe E, Noack S, Weber K. Gastroscopy before cholecystectomy. Gastroenterol J. 1990;50(3):173-4.

Bartosz K, Głuszek S. Need assessment for gastroscopy in patients with gallstones. Polski Przegląd Chirurgiczny. 2010;82(8):469-78.

Ibrahim MTMM, Khair RZAM, Mohamed EY, Massaad AMM. Upper gastrointestinal endoscopic findings in patients with gallstone disease. Khartoum Med J. 2012;5(2):749-52. 110

Jigar V Shah, Sharadchandra Shah. Upper gastrointestinal endoscopy in early diagnosis of gastric disorders. Int J Contemporary Med Res. 2016;3(7):1943-5.

Shanthi Kumari B, Gargi Singh Thakur, Sumana Y. Prevalence of H. Pylori in dyspepsia patients in a tertiary care hospital of Bangalore. Int J Contemp Med Res. 2017;4(2):509-11.