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Euro Gastroenterology 2019 & Clinical Pharmacy 2019
Archives of General Internal Medicine | ISSN: 2591-7951 | Volume 3
Page 29
March 25-26, 2019 | Amsterdam, Netherlands
&
GASTROENTEROLOGY AND HEPATOLOGY
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SURGERY OR UPPER GI ENDOSCOPY IN SYMPTOMATIC GALLSTONES
Chandio A
1
, Naqvi SA
1
, Sabri S
1
, Abbasi M
2
, Shaikh Z
2
, Chandio K
3
Soomro F
3
and
Memon A
3
1
Tameside NHS Foundation Trust Hospital, UK
2
Liaquat University of Medical & Health Sciences, Pakistan
3
Shaheed Mohtarma Benazir Bhutto Medical University, Pakistan
Background:
Gallstones are common; they do not cause any symptoms in many people. About one in three
people with gallstones develop symptoms (symptomatic). There are wide range of gastrointestinal symptoms
have been linked to gallstones but causal relationship has not been established yet. It has always been a chal-
lenge to differentiate between upper gastrointestinal symptoms due to gall stones or any other causes. There
is conflicting evidence that preoperative gastroscopy is useful in identifying medically treatable diseases in pa-
tients undergoing cholecystectomy.
Aim:
To evaluate significance of upper GI endoscopy as a pre-operative investigative tool in symptomatic gall-
stones.
Methods:
Prospective observational multicentre study of 382 patients undergoing Laparoscopic cholecystec-
tomy from July 2014 to December 2015. All patients diagnosed with gallstones based on ultrasound abdomen,
irrespective of age and sex. All patients were subjected to upper gastrointestinal endoscopy 24 to 48 hours
before cholecystectomy biopsy were obtained for histopathology, if required. Those patients not keen for sur-
geries, pregnant ladies due to risk of foetal loss, CBD stone, obstructive jaundice, carcinoma of gall bladder, were
excluded.
Results:
During this period (382 patients) the female to male ratio 4.78:1 (316 versus 66), and the mean pa-
tient age was 46.10 ± 6.31 years (22 to 65 years). 146 (38.21%) patients were present with typical pain and 236
(61.78%) atypical pain. Ultrasound revealed single stone in 83 (21.72%), multiple stones in 299 (78.27%), impact-
ed stone at the neck of gallbladder was found in 68 (17.80%) patients, thick wall gallbladder was seen in 221
(57.85%) patients and contracted gallbladder 44 (11.51%) patients. Pre-operative upper gastrointestinal endos-
copy findings revealed esophagitis in 22 (5.75%) cases, GERD in 26 (6.80%) cases, gastritis in 88 (23.03%), gastric
ulcer 49 (12.82%), duodenal ulcer in 39 (10.20%), polyps 21(5.49%) and carcinoma of stomach 9 (2.35%). In all
patients with typical pain complete relief of symptoms were observed within 15 days post- operatively. Out of
236(61.78%) cases with atypical pain had persistence of symptoms in 141 (59.74%) cases up to four months.
Conclusion:
We recommend that upper gastrointestinal endoscopy should be performed preoperatively in pa-
tients with nonspecific upper abdominal pain and history of peptic ulcer disease.
KeyWords:
Cholecystectomy, Gastroscopy, Cholelithiasis.
Chandio A et al., Arch Gen Intern Med 2019, Volume 3 | DOI: 10.4066/2591-7951-C1-023