Patients with cholelithiasis and history of atypical abdominal pain pr
esent the surgeon with a challenging clinical problem. We hypothesized
that preoperative esophagogastroduodenoscopy before cholecystectomy w
ould identify patients with concomitant upper gastrointestinal patholo
gy. Retrospective review of 143 patients who presented with atypical a
bdominal pain, gallstones, and underwent EGD before their cholecystect
omy between July 1989 and March 1994. A total of 1162 cholecystectomie
s were performed during the study period; 143 patients (12 per cent) u
nderwent a preoperative EGD because of atypical abdominal pain. One hu
ndred ten patients (77 per cent) had normal endoscopies. Thirty-three
patients (23 per cent) had abnormal findings. Gastric polyps were foun
d in three patients and esophageal varices in one patient. There were
36 findings in 29 patients, which included peptic ulcer disease, esoph
agitis, gastritis, and duodenitis. Seven patients had two abnormal fin
dings. Moderate to severe disease was found in a total of 13 (9 per ce
nt) patients. We recommend that patients who present with cholelithias
is and atypical abdominal pain undergo preoperative esophagogastroduod
enoscopy, as we have found that at least 9 per cent of the patient pop
ulation will have significant findings that may alter their management
.