Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones After Sleeve Gastrectomy

Overview

Journal Obes Surg

Date 2015 Sep 7

PMID 26342481

Citations 25

Authors

Lindsay B Adams

Craig Chang

Janet Pope

Yeonsoo Kim

Pei Liu

Amy Yates

Affiliations

Soon will be listed here.

Abstract

Background: Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG.

Methods: Following SG, eligible patients were randomized to a control group who did not receive UDCA treatment or to a group who were prescribed 300 mg UDCA twice daily for 6 months. Gallbladder ultrasounds were performed preoperatively and at 6 and 12 months postoperatively. Patients with positive findings preoperatively were excluded from the study. Compliance with UDCA was assessed.

Results: Between December 2011 and April 2013, 37 patients were randomized to the UDCA treatment arm and 38 patients were randomized to no treatment. At baseline, the two groups were similar. At 6 months, the UDCA group had a statistically significant lower incidence of gallstones (p = 0.032). Analysis revealed no significant difference in gallstones between the two groups at 1 year (p = 0.553 and p = 0.962, respectively). The overall gallstone formation rate was 29.8%.

Conclusions: The incidence of gallstones is higher than previously estimated in SG patients. UDCA significantly lowers the gallstone formation rate at 6 months postoperatively.

Citing Articles

Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy.

Demirpolat M, Celikkaya M, Ertekin S, Basak F, Sisik A BMC Surg. 2025; 25(1):30.

PMID: 39825346 PMC: 11742227. DOI: 10.1186/s12893-025-02767-2.

Correlation Between Bariatric Surgery and the Risk of Multiple Myeloma: Results from an Evidence-Based Strategy.

Wu Q, Zhao T, Zhu C, Da M Obes Surg. 2024; 34(4):1061-1072.

PMID: 38231452 DOI: 10.1007/s11695-024-07059-x.

Ursodeoxycholic Acid Prophylaxis and the Reduction of Gallstone Formation After Bariatric Surgery: An Updated Meta-Analysis of Randomized Controlled Trials.

Al-Huniti M, Alsardia Y, Odeh A, Bdour B, Hassanat R, ALoun A Cureus. 2024; 15(12):e50649.

PMID: 38229797 PMC: 10790195. DOI: 10.7759/cureus.50649.

Role of Ursodeoxycholic Acid in the Prevention of Gallstones Formation in Bariatric Patients-a Systematic Review and Meta-Analysis of Randomised Trials.

Sharma A, Shanti H, Nageswaran H, Best L, Patel A Obes Surg. 2023; 33(12):4115-4124.

PMID: 37872257 DOI: 10.1007/s11695-023-06893-9.

Incidence of symptomatic gallstones after bariatric surgery: the impact of expectant management.

Nogueiro J, Santos-Sousa H, Ribeiro M, Cruz F, Pereira A, Resende F Langenbecks Arch Surg. 2023; 408(1):160.

PMID: 37093281 PMC: 10124697. DOI: 10.1007/s00423-023-02904-6.

References

Schlierf G, Schellenberg B, Stiehl A, Czygan P, Oster P . Biliary cholesterol saturation and weight reduction--effects of fasting and low calorie diet. Digestion. 1981; 21(1):44-9. DOI: 10.1159/000198519. View

Gourash W, Ebel F, Lancaster K, Adeniji A, Koozer Iacono L, Eagleton J . Longitudinal Assessment of Bariatric Surgery (LABS): retention strategy and results at 24 months. Surg Obes Relat Dis. 2013; 9(4):514-9. PMC: 3867134. DOI: 10.1016/j.soard.2013.02.012. View

Villegas L, Schneider B, Provost D, Chang C, Scott D, Sims T . Is routine cholecystectomy required during laparoscopic gastric bypass?. Obes Surg. 2004; 14(2):206-11. DOI: 10.1381/096089204322857573. View

Quesada B, Kohan G, Roff H, Canullan C, Chiappetta Porras L . Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol. 2010; 16(17):2075-9. PMC: 2864832. DOI: 10.3748/wjg.v16.i17.2075. View

Iglezias Brandao de Oliveira C, Chaim E, Silva B . Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003; 13(4):625-8. DOI: 10.1381/096089203322190862. View

Lee C, Cirangle P, Jossart G . Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007; 21(10):1810-6. DOI: 10.1007/s00464-007-9276-y. View

. Ursodeoxycholic acid and gallstones during weight loss. N Engl J Med. 1989; 320(20):1351-3. DOI: 10.1056/NEJM198905183202015. View

Shiffman M, Shamburek R, Schwartz C, Sugerman H, KELLUM J, Moore E . Gallbladder mucin, arachidonic acid, and bile lipids in patients who develop gallstones during weight reduction. Gastroenterology. 1993; 105(4):1200-8. DOI: 10.1016/0016-5085(93)90968-i. View

Marzio L, Capone F, Neri M, Mezzetti A, De Angelis C, Cuccurullo F . Gallbladder kinetics in obese patients. Effect of a regular meal and low-calorie meal. Dig Dis Sci. 1988; 33(1):4-9. DOI: 10.1007/BF01536623. View

10.

Sugerman H, Brewer W, Shiffman M, Brolin R, Fobi M, LINNER J . A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995; 169(1):91-6; discussion 96-7. DOI: 10.1016/s0002-9610(99)80115-9. View

11.

DHondt M, Sergeant G, Deylgat B, Devriendt D, Van Rooy F, Vansteenkiste F . Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass?. J Gastrointest Surg. 2011; 15(9):1532-6. DOI: 10.1007/s11605-011-1617-4. View

12.

Stone B, Ansel H, Peterson F, GEBHARD R . Gallbladder emptying stimuli in obese and normal-weight subjects. Hepatology. 1992; 15(5):795-8. DOI: 10.1002/hep.1840150508. View

13.

Fisher R, Rock E, Malmud L . Effects of meal composition on gallbladder and gastric emptying in man. Dig Dis Sci. 1987; 32(12):1337-44. DOI: 10.1007/BF01296658. View

14.

Roa P, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal R . Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006; 16(10):1323-6. DOI: 10.1381/096089206778663869. View

15.

Vix M, Diana M, Liu K, DUrso A, Mutter D, Wu H . Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass: results of a prospective randomized clinical trial. Obes Surg. 2012; 23(5):613-21. DOI: 10.1007/s11695-012-0827-5. View

16.

Li V, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P . Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc. 2008; 23(7):1640-4. DOI: 10.1007/s00464-008-0204-6. View

17.

Williams , Gowan , Perey . A Double-Blind Placebo-controlled Trial of Ursodeoxycholic Acid in the Prevention of Gallstones during Weight Loss after Vertical Banded Gastroplasty. Obes Surg. 1993; 3(3):257-259. DOI: 10.1381/096089293765559278. View

18.

Jamal M, Wegner R, Heitshusen D, Liao J, Samuel I . Resolution of hyperlipidemia follows surgical weight loss in patients undergoing Roux-en-Y gastric bypass surgery: a 6-year analysis of data. Surg Obes Relat Dis. 2010; 7(4):473-9. DOI: 10.1016/j.soard.2010.08.009. View

19.

Nguyen N, Nguyen B, Gebhart A, Hohmann S . Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2012; 216(2):252-7. DOI: 10.1016/j.jamcollsurg.2012.10.003. View

20.

Reuben A, Qureshi Y, Murphy G, Dowling R . Effect of obesity and weight reduction on biliary cholesterol saturation and the response to chenodeoxycholic acid. Eur J Clin Invest. 1986; 16(2):133-42. DOI: 10.1111/j.1365-2362.1986.tb01320.x. View