Routine preoperative upper gastrointestinal series (UGIS) in patients with biliary tract disease: a plea for more selectivity.

Preoperative upper gastrointestinal x-ray series (UGIS) in patients with documented biliary tract disease commonly is carried out before cholecystectomy. Of 250 patients who had consecutive cholecystectomies performed in a 400-bed private hospital, 105 patients did not have UGIS prior to operation and no gastroduodenal disease was discovered at operation. Thirty-nine positive x-ray examinations were obtained among the 145 patients who had preoperative UGIS. In only three of these patients was a gastric procedure added at operation; no unexpected cancers were found. In the other 36, "positive" findings consisted of small hiatal hernias, diverticula of the esophagus, stomach, or duodenum not clinically significant or postgastrectomy anatomic abnormalities. This review suggests that routine preoperative UGIS may not be warranted in such patients and urges greater selectivity of patients having this procedure.