The Significance and Indications for Routine Pre-Operative Upper Gi Endoscopy in patients with Cholelithiasis Undergoing Laparoscopic Cholecystectomy

Abstract

Objective
Cholelithiasis is one of the most common surgical conditions encountered in clinical practice. While typical biliary colic results from transient obstruction of the cystic duct leading to gallbladder distension, many patients present with atypical gastrointestinal symptoms such as dyspepsia, nausea, belching, heartburn, flatulence, vomiting, and loss of appetite. This study aimed to evaluate the role of upper gastrointestinal endoscopy (UGE) in identifying associated UGI lesions and correlating gastrointestinal symptoms with gallstone disease.

Methods
This is a prospective and retrospective observational study. Patients with symptomatic cholelithiasis diagnosed on imaging were included. Both patients with typical and atypical symptoms were enrolled after obtaining consent. Clinical data, imaging, UGE results, biopsy reports, treatment details and postoperative outcomes were  recorded and analysed.

Results
A total of 111 patients with atypical biliary symptoms demonstrated a significantly higher incidence of abnormal UGI endoscopic findings compared to those with typical symptoms. Persistence of postoperative symptoms showed a strong association with atypical preoperative presentation. Most patients with typical biliary symptoms were symptom-free by the end of four weeks postoperatively, whereas a substantial proportion of patients with atypical symptoms continued to have persistent complaints. This association was statistically significant.

Conclusion
Upper gastrointestinal endoscopy plays an important role in the preoperative evaluation of symptomatic patients. Selective use of UGE, particularly in patients with atypical symptoms, helps identify coexisting gastrointestinal lesions and may reduce postoperative symptoms and help in a faster recovery.