Publication:

Oesophagogastroduodenoscopy in patients with incidental cholelithiasis, its significance and therapeutic value: an observational study

Background Cholelithiasis along with other causes of upper abdominal pain, have a similar mode of presentation. Often the cholelithiasis is an incidental finding not causative. Aims and objectives of this study was to determine the role of oesophagogastroduodenoscopy (OGDscopy) in patients presenting with upper abdominal pain and sonographically documented cholelithiasis being considered for cholecystectomy and to eliminate the confounding causes of pain and avoiding cholecystectomy in incidental cholelithiasis.

Methods 200 patients with upper abdominal pain (typical/atypical) and sonographically documented gallstones underwent OGDscopy. Patients with normal OGDscopy underwent cholecystectomy while it was deferred in those with positive OGDs copy findings. These patients were appropriately managed and followed up with a repeat OGDscopy at 6 weeks. All patients were re-assessed for resolution of symptoms at 6 weeks and those with persistence of symptoms in spite of a normal OGDscopy on reassessment were then subjected to cholecystectomy. Pearson’s chi-square test was applied to study association between type of pain (typical/atypical) and OGDscopy findings and type of pain (typical/atypical) and requirement for cholecystectomy.

Results Of the 200 patients, 120 presented with typical and 80 with atypical pain. Among those with atypical pain (n = 80), a significant 95% (76/80) had positive findings on OGDscopy while none of those with typical pain had positive finding on OGDscopy (p<0.005). Cholecystectomy to relieve pain was needed in all 120 patients with typical pain while only 17.5% (14/80) of those with atypical pain required cholecystectomy (p<0.005).

Conclusions The study shows that OGDscopy in patients with cholelithiasis can suggest alternative management plan particularly in those with atypical pain.