The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial

Pizza, Francesco; D’Antonio, Dario; Lucido, Francesco Saverio; Tolone, Salvatore; Genio, Gianmattia del; Dell’Isola, Chiara; Docimo, Ludovico; Gambardella, Claudio

doi:10.1007/s11695-020-04801-z

Cited by 34 publications

(29 citation statements)

References 24 publications

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“…Studies suggest the first 6 months after surgery to be the most critical because they are associated with the greatest reduction in body weight, with UDCA showing mild benefits after the first 6 months that do not justify prolonged prophylaxis [88]. A recent randomized study assessed the effects of prophylactic UDCA on the incidence of gallstones in 190 patients undergoing 1 anastomosis gastric bypass [89]. These patients were randomized to either 600 mg/day of oral UDCA ( n = 95) or to a control group ( n = 95) for 6 months.…”

Section: Prevention and Treatment Of Gallstones In Obesitymentioning

confidence: 99%

Excess Body Weight and Gallstone Disease

Stokes

Lammert

2021

Visc Med

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Background: Approximately one fifth of adults are diagnosed with gallstones worldwide. Of these, around 25% develop gallstone disease (indicated by the presence of symptoms) and undergo cholecystectomy. Summary: The risk of gallstones is influenced by a combination of genetic and lifestyle factors, such as excess body weight. In fact, body mass has been demonstrated to be a major risk factor for symptomatic gallstones. Rapid weight loss can also initiate a prolithogenic state and further increase the likelihood of either gallstone formation or existing gallstones becoming symptomatic; however, sensible weight loss strategies can mitigate this risk. This review discusses the role of excess body weight and the risk of gallstone disease, as well as the options available for the prevention of symptomatic gallstones. Key Messages: Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones. Should rapid weight loss be required for health reasons or be expected, e.g., after bariatric surgery, prophylactic ursodeoxycholic acid during the period of weight reduction has been demonstrated to reduce the incidence of gallstones formation or symptomatic gallstone occurrence. The recent German guidelines on gallstones recommend simultaneous cholecystectomy during bariatric surgery but only for those with preexisting symptomatic stones.

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Section: Prevention and Treatment Of Gallstones In Obesitymentioning

confidence: 99%

Excess Body Weight and Gallstone Disease

Stokes

Lammert

2021

Visc Med

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“…9,10 The prophylactic efficacy of UDCA for gallstone formation following gastric surgery, which is without severe clinical burden to the patient, is well-proven to be superior to the control groups in recent RCTs, regardless of the indication for the gastric surgery. 20,39,40 However, no solid evidence has been suggested that might persuade those who insist on the need for a PC, concomitant with gastric surgery, to use UDCA instead, despite the poor cost-effectiveness of a PC. We expected that patients receiving a UDCA in this study would show a clearly superior outcome over patients without any preventive methods.…”

Section: Discussionmentioning

confidence: 99%

“…Patients may suffer from gallstones following gastric surgery, but there seems to be a dilemma regarding the need for a PC with its invasiveness, because the incidence of symptomatic cases needing invasive treatment is quite low 9,10 . The prophylactic efficacy of UDCA for gallstone formation following gastric surgery, which is without severe clinical burden to the patient, is well‐proven to be superior to the control groups in recent RCTs, regardless of the indication for the gastric surgery 20,39,40 . However, no solid evidence has been suggested that might persuade those who insist on the need for a PC, concomitant with gastric surgery, to use UDCA instead, despite the poor cost‐effectiveness of a PC.…”

Section: Discussionmentioning

confidence: 99%

Ursodeoxycholic acid for the prevention of gallstone and subsequent cholecystectomy following gastric surgery: A systematic review and meta‐analysis

Choi

Lee

Cho

et al. 2021

J Hepato Biliary Pancreat

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Background/Purpose: Patients who undergo gastric surgery are prone to form postsurgical gallstones. Debates still exist about the need for prevention and the selection of preventive methods. No studies had been reported comparing the efficacy of prophylactic ursodeoxycholic acid (UDCA) and prophylactic cholecystectomy (PC) for lowering postsurgical gallstone formation and subsequent cholecystectomy (SC) in patients who have undergone gastric surgery. Methods: We did a systematic review to identify studies from PUBMED, EMBASE, and the Cochrane database through 30 June 2020. We conducted direct and indirect comparisons of each prophylaxis using conventional and network meta-analysis.Studies with patients who have no history of cholecystectomy and who have not had preoperative gallstone were included. Results: The excellent preventive effects of PC and UDCA were demonstrated for gallstone formation (odds ratio [OR] 0.05, [95% CI 0.01, 0.22] and 0.20, [95% CI 0.16, 0.24], respectively) and the need for SC (OR 0.10, [95% CI 0.02, 0.57] and OR 0.22, [95% CI 0.14, 0.35], respectively) than control group. The UDCA group showed a tendency to generate more gallstones (OR 3.74, [95% CI 0.88, 15.82]) and a greater need for SC (OR 2.19,) than did the PC group without statistical significance. Conclusions: Prophylaxis for gallstone formation may be needed for patients who undergo gastric surgery to reduce troublesome morbidities. Prophylactic UDCA seems to be a reasonable preventive method for postsurgical gallstone formation to ensure clinical benefit while reducing the burden of subsequent cholecystectomy for the patient as compared to a PC.

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“…Нами проведен литературный поиск в сети MEDLINE: поисковый запросbariatric surgery AND ursodeoxycholic acid. Найдено 12 исследований применения урсодезоксихолевой кислоты после бариатрических операций [6][7][8][9][10][11][12][13][14][15][16][17][18]. Во всех работах было показано снижение частоты возникновения конкрементов в желчном пузыре при использовании профилактических дозировок препарата (табл.…”

Section: Discussionunclassified

Ursodeoxycholic acid for the prevention of gallstone disease after bariatric surgery

Смирнов

Вячеславович²,

Ivanov

et al. 2021

Journal of Clinical Practice

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Background: The development of gallstone disease (GSD) after bariatric surgery is a significant problem. The prophylactic effect of ursodeoxycholic acid (UDCA) preparations on the occurrence of cholelithiasis after gastric bypass and longitudinal gastrectomy has been studied. Aims: The aim of the study was to evaluate the effectiveness of ursodeoxycholic acid preparations in the prevention of cholelithiasis in patients after bariatric surgery. Methods: The results of a year-long follow-up for 128 patients after bariatric surgery were analyzed. In 68 patients, the prophylaxis of the gallstone disease development was not performed. 60 patients took a daily 500 mg dose of UDCA orally. Results: Cholelithiasis had developed in 17 (25%) patients who did not undergo the prophylaxis of cholelithiasis. Of these, 10 (14.7%) underwent cholecystectomy. Among those patients who took UDCA drugs, stones in the gallbladder were found in 7 (11.6%), and only one patient (1.7%) required a surgical treatment. Conclusion: UDCA administration during the first year after bariatric surgery in the amount of 500 mg per day significantly reduces the likelihood of the de novo cholelithiasis development. The medical prophylaxis of gallstone disease should be included in the standards of bariatric patients' management.

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The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial

Cited by 34 publications

References 24 publications

Excess Body Weight and Gallstone Disease

Excess Body Weight and Gallstone Disease

Ursodeoxycholic acid for the prevention of gallstone and subsequent cholecystectomy following gastric surgery: A systematic review and meta‐analysis

Ursodeoxycholic acid for the prevention of gallstone disease after bariatric surgery

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