Role of routine upper gastro intestinal endoscopy in patients of cholelithiasis presenting with dyspepsia in rural set-up

Abstract

Background : Cholelithiasis is one of the most common problems encountered in surgery department. Symptoms may be acute or chronic. Chronic symptoms are usually dyspeptic. Dyspeptic symptoms are also present in other upper (Gastro intestinal) GI pathologies. UGIE is investigation of choice for definitive diagnosis of upper GI pathologies. Upper GI endoscopy and endoscopist still are not easily available in rural or small towns, CHC or district hospital in India. So it is not easy to perform routine upper GI endoscopy in all patients of cholelithiasis with dyspepsia in these set ups. Endoscopy also gives economic burden to the poor patients. So our study questioned is it really necessary to perform upper GI endoscopy in all patients of cholelithiasis presenting with dyspepsia and to identify the various common UGI pathologies seen on UGIE in all cholelithiasis patients with dyspepsia in rural population. Methods: Present study was carried out in department of surgery in UP Rural Institute of Medical Science and Research, Saifai, Etawah (U.P.) during January 2014 to august 2015. 100 patients admitted under IPD were taken for the study, considering the exclusion and inclusion criteria. Results: In our study, it was found that, dyspepsia with gall-stones was commonly seen in females in 30-60 year age group in rural patients. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. As in our study at three month postoperatively 99% showed no any type of dyspeptic symptom. Conclusions: Routine pre-operative upper GI endoscopy could not be recommended in all (for our study population as well) patients with gall-stone disease who present with dyspepsia as at the end of 3 months postoperatively 99% patients were symptom free in our study. If symptoms persists even after surgery now patient can be considered for upper G.I. endoscopy to rule out other causes of dyspepsia.