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Upper Gastrointestinal Endoscopy Prior to Laparoscopic Cholecystectomy: a Clinical Study at a Tertiary Care Centre in Central India

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Upper Gastrointestinal Endoscopy Prior to Laparoscopic Cholecystectomy: a Clinical Study at a Tertiary Care Centre in Central India International Surgery Journal K olla V et al. Int Surg J. 2016 May;3(2):637-642 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20161136 Research Article Upper gastrointestinal endoscopy prior to laparoscopic cholecystectomy: a clinical study at a tertiary care centre in central India Venkatesh Kolla, Neelam Charles*, Sanjay Datey, Devendra Mahor, Anand Gupta, Sanjeev Malhotra Department of General Surgery, SAMCPGI, Indore, MP, India Received: 11 January 2016 Revised: 21 February 2016 Accepted: 29 February 2016 *Correspondence: Dr. Neelam Charles, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Cholelithiasis is one of the most common problems encountered in surgery. It’s an immense challenge to discriminate between gastrointestinal symptoms due to gall stones or any other causes. These gastrointestinal symptoms have been related to gallstones but causal relationship has not been established yet, which is highly discouraging for the operating surgeon. An objectives of the study was to analyze the use of upper gastrointestinal endoscopy (UGE) as a pre-operative investigative tool in gallstone disease patients presenting with chronic dyspepsia. Methods: This prospective observational study was conducted on 216 patients at Department of Surgery at Aurobindo PG institute. The data collected from the patients included personal information, presenting signs and symptoms, investigations including USG, UGE finding, biopsy reports if present, medications, surgery details, any post-operative complications. Statistical analysis done by chi-square test. Results: Out of total patients, the mean age was 38.61 + 13.2 years. The male to female ratio was 1:3.one hundred and sixty (74.1%) patients had multiple stones. UGE showed a predominance of positive findings in group II with atypical symptoms than in group I (p-0.004). Therapeutic approach was changed in a total of 10 (4.6%), who were diagnosed with ulcer, malignancy and celiac disease. Cholecystectomy was performed in 206 (95.4%) patients. The relief rate is highest in group I with negative UGE than with group II. Conclusions: Besides its cost effectiveness, UGE is potentially helpful in reducing the incidence of postoperative persistence of symptoms. Thus UGE has a vital role in the initial evaluation and investigation of patients with symptomatic gallstone patients. Keywords: Cholelithiasis, Endoscopy, Dyspepsia, USG, Cholecystectomy INTRODUCTION cholecystectomy is highly discouraging for surgeons. Coexistence of concurrent upper gastrointestinal Cholelithiasis is one of the most common problems problems in gallstones disease patients may have encountered in surgery. It’s an immense challenge to attributed to the post cholecystectomy syndrome.1-3 discriminate between upper gastrointestinal (UGI) Although, gallstone disease is asymptomatic in the vast symptoms due to gall stones or any other causes. These majority of individuals, it is frequently accepted that gastrointestinal symptoms have been related to gallstones removal of the gallbladder is the best treatment for but causal relationship has not been established yet. The symptomatic gallstone disease. However, less emphasis persistence of abdominal symptoms even after International Surgery Journal | April-June 2016 | Vol 3 | Issue 2 Page 637 Kolla V et al. Int Surg J. 2016 May;3(2):637-642 has been on patient selection and symptomatology of this Patients not willing to participate in study and lost to disease in order to understand prevailing symptoms after follow-up. surgery. Evaluation of gall stone disease is an immense challenge RESULTS as to ascertain whether gallstones are responsible for symptoms or incidental findings. Differentiating between This observational study includes a total of 216 patients, these two situations is important, because the prevalence age ranges from 25-72 years for both female and male of both conditions is common in the general population. with mean age of 38.61+13.2 years. Youngest patient was This study focuses on the yield of upper gastrointestinal 27 years old whereas oldest patient was 70 years for male endoscopy as an investigative modality to find out other and youngest patient was 25 years old whereas oldest associated disorders of upper gastrointestinal tract in patient was 72 years for female. In present study 71.3 % patients with ultra-sonogram proven gallstones presenting (N-154) of them were female and 27.7% (N-62) were with dyspeptic symptoms. The objective of this study was males, there was a female preponderance with a male to to analyze the use of upper gastrointestinal endoscopy female ratio of 1:3.5 in general. Presence of gallstones (UGE) as a pre-operative investigative tool in gallstone was confirmed by ultrasonography and 74.1% (N-160) of disease patients presenting with chronic dyspepsia. the patients had multiple stones. METHODS Table 1: Comparison between groups. This hospital based prospective observational study was Typical symptoms Atypical symptoms conducted from Jan 2013 to Dec 2014 in the Department of Surgery, Sri Aurobindo hospital and PG teaching (group I) (group II) institute (SAMCPGI). Institutional approval was taken No. of patients 98 (42.5%) 118 (57.5%) for the study. Informed consent was taken from each Mean age of participant. The data collected from the patients included presentation 41.72 years 35.5 years personal information, presenting signs and symptoms, (years) Male/Female investigations including ultrasonography, UGE finding, 1:3.1 1:4.6 biopsy reports if present, medications, surgery details, ratio any post-operative complications and findings. A total of UGI endoscopy 84(71.2%) 51(52.1%) 216 patients were included in the study who were divided positive findings (p-0.004) in to two groups based on symptomatology, first group History of (N-98) in which patient present with typical symptoms of attack of 75(76.5%) 48(40.7%) biliary colic and second group (N-118) in which patients cholecystitis present with atypical symptoms or dyspepsia (abdominal *p value <0.005 is significant. discomfort, nausea, belching, heart burn, food intolerance, flatulence, vomiting, loss of appetite). Table 1 showing the comparison between the two groups Patients who lost to follow up or left the hospital against which showed that mean age of presentation in group I is advice were excluded. 41.72years and in group II is 35.5 years and male to female ratio shows a female preponderance in both All patients were subjected to UGI endoscopy 1 or 2 days groups (group II > group I). UGE showed a prior to operation and the endoscopic findings were predominance of positive findings in group II rather than divided as normal, inflammatory, hiatus hernia, ulcers group I, i.e. atypical greater than typical group(p-0.004) and others. Similar categorizations were applied for Patients with a clear cut history of previous attack of histopathological findings as well. The patients were cholecystitis 75 (76.5%) of patients in group I and th th th followed up postoperatively on 7 , 14 , 30 day, and 6 48(40.7%) of patients in group II. months to evaluate the presence of any dyspeptic symptoms. Table 2 shows UGI endoscopy findings, Out of 98 patients, and 47 (47.9%) patients showed normal findings Inclusion criteria and 51 (52.1%) patients showed abnormal findings in Patients of gall bladder stones as demonstrated on group I with atypical symptoms and patients were ultrasound, which are willing to participate in the subjected to biopsy in case of ulcer or any abnormal study. pathology. Patients presenting with any one of the following Most common findings being the gastritis (30.6%), hiatus symptoms pain or discomfort in upper abdomen, hernia (10.2%), duodenitis (10.2%), reflux oesophagitis nausea or vomiting, early satiety, bloating or fullness (7.14%), gastric ulcer (1.02%), duodenal ulcer (1.02%), of abdomen. others including gastric polyp and gastric tumors Exclusion criteria (3.06%), with histopathological finding suggestive of Helicobacter pylori related ulcers in stomach and Patients with acute cholecystitis or general condition duodenum, carcinoma stomach. are not stable. International Surgery Journal | April-June 2016 | Vol 3 | Issue 2 Page 638 Kolla V et al. Int Surg J. 2016 May;3(2):637-642 Table 2: distribution of endoscopic findings in group (9.32%), gastric ulcer (2.54%), duodenal ulcer (1.69%), with typical symptomatology. others including candidial oesophagitis and celiac disease (3.39%), with histopathological finding suggestive of Endoscopic Histopathological No. Percentage H.pylori related ulcers in stomach and duodenum and Findings findings celiac disease. Normal 47 47.9 Not done Gastritis / pan 30 30.6 Not done Table 3: Distribution of endoscopic findings in group gastritis with atypical symptomatology. Hiatus hernia 10 10.2 Not done Endoscopic Histopathologic Duodenitis 10 10.2 Not done No. Percentage Reflux Findings al findings 7 7.14 Not done esophagitis Normal 34 28.8 Not done Gastric ulcer 1 1.02 1(1.02%) Gastritis / pan 48 40.67 Not done Duodenal ulcer 1 1.02 1(1.02%) gastritis Others(gastric Hiatus hernia 36 30.51 Not done polyp, gastric 3 3.06 3(3.06%) tumors) Duodenitis 18 15.28 Not done Reflux 11 9.32 Not done Table 3 shows UGI endoscopy findings, Out of 118 esophagitis patients, 34(28.8%) patients showed normal findings and Gastric ulcer 3 2.54 3(2.54%) 84(71.2%) patients showed abnormal findings in group II Duodenal ulcer 2 1.69 2(1.69%) with atypical symptoms subjected to biopsy in case of Others ulcer or any abnormal pathology. (candidial 4 3.39 2(1.69%) esophagitis,celi Most common being the gastritis(40.67%), hiatus hernia (30.51%), duodenitis (15.28%), reflux oesophagitis ac disease) Table 4: Comparison of preoperative and postoperative relief of symptoms.
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