Should Upper Gastrointestinal Endoscopy Be Routine Before Laparoscopic Cholecystectomy? A Prospective Study of Diagnostic Yield in Symptomatic Cholelithiasis

Abstract

Background: Symptomatic cholelithiasis is a common indication for elective laparoscopic cholecystectomy, yet the presence of gallstones does not invariably explain upper abdominal symptoms. Objective: To evaluate the diagnostic yield and clinical utility of preoperative upper gastrointestinal (UGI) endoscopy in patients with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy. Methods: This prospective observational study was conducted at a tertiary care centre from October 2019 to October 2021. Seventy-one consecutive patients with clinically and ultrasonographically confirmed symptomatic cholelithiasis underwent preoperative UGI endoscopy. Demographic and clinical data were recorded. Endoscopic findings were analysed using descriptive statistics (SPSS v20). The primary outcome was detection of clinically significant UGI pathology. Results: The cohort comprised 44 females (62.0%) and 27 males (38.0%), with 64.8% aged <40 years. Significant endoscopic abnormalities were identified in 36 patients (50.7%), while 35 (49.3%) had normal findings. Gastritis was the most common lesion (33.3%), followed by antral gastritis (22.2%) and reflux esophagitis (13.9%). Inflammatory and reflux-related lesions accounted for the majority of abnormalities. More than half (55.6%) of significant findings occurred in patients younger than 40 years. Lesion distribution was broadly similar between sexes. Conclusions: Preoperative UGI endoscopy demonstrated a high diagnostic yield in patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis, identifying clinically relevant mucosal pathology in approximately half of cases. The substantial coexistence of upper GI disease highlights the potential value of a structured, symptom-oriented endoscopic strategy to optimise diagnostic precision and perioperative management. Further multicentre studies incorporating long-term symptom outcomes and cost-effectiveness analyses are warranted.