Ursodeoxycholic Acid in the Prevention of Gallstone Formation after Bariatric Surgery: A Meta-analysis

Uy, Manley C; Talingdan-Te, Marilyn C; Espinosa, Wendell; Daez, Ma Lourdes O; Ong, Janus P.

doi:10.1007/s11695-008-9587-7

Cited by 128 publications

(63 citation statements)

References 11 publications

(35 reference statements)

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“…It also acts by decreasing the biliary nidus forming factors by reduction of glycoprotein secretion and dissolution of gallstones (11). A meta-analysis concluded that the daily administration of 500 mg UDCA is an effective method of preventing gallstone formation after bariatric surgery (11).…”

Section: Discussionmentioning

confidence: 99%

“…These are performing cholecystectomy simultaneously with gastric bypass regardless of the presence of gallstones (prophylactic approach) (6)(7)(8), performing simultaneous cholecystectomy in all patients with gallstones (elective or selective approach) (9, 10), performing simultaneous cholecystectomy in patients with symptomatic gallstones, and methods in which prophylactic ursodeoxycholic acid (UDCA) therapy was initiated or not until development of symptoms (conventional approach) (5,11).…”

Section: Introductionmentioning

confidence: 99%

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The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Karadeniz¹,

Görgün²,

Kara³

2014

UCD

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Objective: This study aimed to evaluate gallstone formation, prophylactic and selective cholecystectomy and the effectiveness of ursodeoxycholic acid treatment following laparoscopic Roux-en -Y gastric bypass (LRYGB) in morbid obese patients. Results: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three patients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients. Conclusion:In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Karadeniz¹,

Görgün²,

Kara³

2014

UCD

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“…This pattern of incidence (higher in the phase of greater weight loss) has motivated several surgeons to use ursodeoxycholic acid in the first 6 postoperative months [14][15][16]. This drug is a bile acid that prevents biliary lithiasis by decreasing cholesterol and mucin concentration, increasing bile acid concentration, decreasing bile saturation, and enhancing gallbladder emptying [16,33]. Various risk factors for formation of gallstones are known, in the general population, such as age, obesity, female gender, parity, positive family history, use of contraceptives, etc.…”

Section: Open Access Ssmentioning

confidence: 99%

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

Abo-Ryia¹,

Abdallah²,

El-Khadrawy³

et al. 2014

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Background: Obesity alone and rapid weight loss induced by bariatric surgery are recognized risk factors for the development of cholelithiasis. This study aimed to identify the predictive factors for gallstone formation after bariatric surgery. Patient and methods: The files of all morbidly obese patients underwent bariatric surgery in our unit during the period from March 2003 till October 2010 were reviewed and analyzed. All patients underwent routine preoperative ultrasonography and selective concomitant cholecystectomy was done in all patients with ultrasonographic-confirmed cholelithiasis. After excluding cases with prior and concomitant cholecystectomies, patients were divided into two groups; those who developed gallstones and those who did not and the two groups were compared. Results: Of the 143 reviewed files 135 were eligible to be included in the study. The incidence of cholelithiasis before surgery was 25.9% (35 cases). 19 cases (19%) of the 100 cases free at surgery developed gallstone at a mean of 13.2 months. Comparing the two groups, no significant difference was revealed regarding gender, age, preoperative BMI or type of the operation. But the percent of excess weight loss was significantly higher in the group that formed gallstones. Conclusion: Gender, age, preoperative BMI and type of the operation were not predictive of gallstones formation after bariatric surgery. The percent of excess weight loss was the only predictive postoperative factor.

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“…53) UDCA, which is litholytic and hydrophilic, greatly decreases the risk of cholesterol gallstone formation (<10%) and of gallstones be-coming symptomatic, 58) following rapid weight loss. 58,59) A meta-analysis of 5 randomized controlled trials including 521 patients (322 taking UDCA and 199 taking a placebo) concluded that UDCA 300-1,200 mg/d effectively prevents gallstone formation after bariatric surgery, 59) reducing the incidence from 32% to 2%, 60) with no severe side effects.…”

Section: ) Obese Patients Undergoing Rapid Weight Lossmentioning

confidence: 99%

Preventing a Mass Disease: The Case of Gallstones Disease. Role and Competence for Family Physicians

Grattagliano¹

2015

J Fam Med Dis Prev

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Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case-controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting.

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Ursodeoxycholic Acid in the Prevention of Gallstone Formation after Bariatric Surgery: A Meta-analysis

Abstract: UDCA can prevent gallstone formation after bariatric surgery.

Cited by 128 publications

References 11 publications

The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

Preventing a Mass Disease: The Case of Gallstones Disease. Role and Competence for Family Physicians

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