Precholecystectomy esophagogastroduodenoscopy: is it of value?

Patients with cholelithiasis and history of atypical abdominal pain present the surgeon with a challenging clinical problem. We hypothesized that preoperative esophagogastroduodenoscopy before cholecystectomy would identify patients with concomitant upper gastrointestinal pathology. Retrospective review of 143 patients who presented with atypical abdominal pain, gallstones, and underwent EGD before their cholecystectomy between July 1989 and March 1994. A total of 1162 cholecystectomies were performed during the study period; 143 patients (12 per cent) underwent a preoperative EGD because of atypical abdominal pain. One hundred ten patients (77 per cent) had normal endoscopies. Thirty-three patients (23 per cent) had abnormal findings. Gastric polyps were found in three patients and esophageal varices in one patient. There were 36 findings in 29 patients, which included peptic ulcer disease, esophagitis, gastritis, and duodenitis. Seven patients had two abnormal findings. Moderate to severe disease was found in a total of 13 (9 per cent) patients. We recommend that patients who present with cholelithiasis and atypical abdominal pain undergo preoperative esophagogastroduodenoscopy, as we have found that at least 9 per cent of the patient population will have significant findings that may alter their management.