Need Assessment for Gastroscopy in Patients with Gall-Stones
Cholelithiasis (gall-stones) occurs in 13% of the Polish population. Patients affected with gall-stones notify non-specific symptoms caused by pathology of the upper segment of the digestive track which coexists with gall-stones.
The aim of the study was to analyze the risk of occurrence of pathological changes, within the part of the digestive track in patients affected with gall-stones, to assess the correlation between data of medical histories of patients and results of gastroscopy based diagnosis; to devise tactics of alterations to the planned measures in case a clinically significant disease has been diagnosed.
Material and methods. The study group comprised 615 patients, qualified for cholecystectomy, with symptomatic gall-stones, verified by an ultrasound diagnosis. After being interviewed and examined, all the patients were subjected to gastroscopy, and when necessary biopsy was performed. The statistical analysis was performed using an multifactorial analysis (Pearson's correlation coefficient for categorical variables).
Results. Among 615 patients, the subjects in the study, we found 183 ones (29.7%) with a normal upper digestive tract, we found pathology of the upper digestive system in 70.3% cases (432 patients). Serious pathology resulting in changing the planned treatment was found in 83 patients (13.5%): among those four ones had gastric carcinoma, sixty-three ones suffering from chronic peptic ulcer disease (gastric or/and duodenal), twelve patients were affected with hemorrhagic gastritis, four patients had GERD C and D. In a group of 83 patients cholocystectomy was postponed and the diagnosed disease was treated. Four patients were operated on because of gastric cancer, with intention of cure.
Conclusions. 1. Routine gastroscopy performed before cholecystectomy is justified. The percentage of abnormalities diagnosed during gastroscopy proved the above mentioned thesis. 2. Medical histories and an object examination do not allow to state explicitly that there is another disease of the upper part of the digestive system which coexists with gall-stones. In case of diagnosing the other pathology it is necessary to take into consideration an alteration of tactics of management: to delay an operation and treat the other disease which has been diagnosed.