Should We Perform Routine Upper Gastrointestinal Endoscopy Before Cholecystectomy?

Abstract

In some patients, there is not any symptomatic relief after cholecystectomy due to the overlap of the symptoms of biliary and gastroduodenal pathologies known as postcholecystectomy syndrome. The aim of this study was to assess the effectiveness of upper gastrointestinal (UGI) endoscopy in reducing the possibility of postcholecystectomy syndrome. This retrospective study was conducted in 194 cases. In patients sampled for histopathologic examination, screening for Helicobacter pylori and intestinal metaplasia was carried out with Giemsa stain and PAS-Alcian stain. Patients who did not undergo UGI endoscopy before operation were designated as Group A (n ¼ 100) and those who underwent routine UGI endoscopy before operation were called Group B (n ¼ 94). Symptomatic relief after cholecystectomy and endoscopic findings were evaluated. Thirty-one of the 39 patients diagnosed with H. pylori, underwent eradication treatment. Seven of the 31 patients undergoing H. pylori eradication during the preoperative period had ongoing symptoms at the postoperative period. On the other hand, only 2 of 8 patients who did not undergo H. pylori eradication during the preoperative period had unremitting symptoms during the postoperative period. Only three of 100 patients who did not receive a UGI endoscopy during the preoperative period had unremitting symptoms during the postoperative period. The main outcome of the study is to evaluate the necessity of performing routine UGI endoscopy before cholecystectomy. Our results show that it is not necessary, because if you take biliary colic as the one and only symptom of indication for cholecystectomy, the ratio of postcholecystectomy syndrome is 3% to 5% and the reason is 50% organic.

Routine upper gastro-intestinal tract endoscopy before elective cholecystectomy for symptomatic gallstones-justified

“…Consequently, a number of patients may undergo cholecystectomy, the management of choice for symptomatic gallstone disease 4,5 , while the actual cause of their symptoms is a different UGI pathology 10,11,13,14 . Such patients may continue to experience UGI symptoms after successful and uneventful cholecystectomy as postcholecystectomy syndrome [15][16][17][18] . Although there are other possible causes of postcholecystectomy syndrome [19][20][21][22][23] , most concurrent UGI pathology can be readily diagnosed by UGI endoscopy and appropriately treated before elective cholecystectomy 24 .…”