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01-11-2017 | Review Article

Ursodeoxycholic Acid in the Prevention of Gallstone Formation After Bariatric Surgery: an Updated Systematic Review and Meta-analysis

Authors: Dimitrios E. Magouliotis, Vasiliki S. Tasiopoulou, Alexis A. Svokos, Konstantina A. Svokos, Christina Chatedaki, Eleni Sioka, Dimitris Zacharoulis

Published in: Obesity Surgery | Issue 11/2017

Abstract

We aim to review the available literature on obese patients treated with ursodeoxycholic acid (UDCA) in order to prevent gallstone formation after bariatric surgery. A systematic literature search was performed in PubMed, Cochrane library, and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 1355 patients. Random-effects meta-analysis showed a lower incidence of gallstone formation in patients taking UDCA. Subgroup analysis reported fewer cases of gallstone disease in the UDCA group in relation to different bariatric procedures, doses of administered UDCA, and time from bariatric surgery. Adverse events were similar in both groups. Fewer patients required cholecystectomy in UDCA group. No deaths were reported. The administration of UDCA after bariatric surgery seems to prevent gallstone formation.

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Go AS, Mozaffarian D, Roger VL, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:143–52.CrossRefPubMed

Colquit JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2:CD003641.

Magouliotis DE, Tasiopoulou VS, Sioka E, et al. Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. Obes Surg. 2017;27:245. https://doi.org/10.1007/s11695-016-2444-1.CrossRefPubMed

Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. One-anastomosis gastric bypass versus sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. Obes Surg. 2017;27(9):2479–87. https://doi.org/10.1007/s11695-017-2807-2.CrossRefPubMed

Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55:652–8.PubMed

Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol. 1993;88(10):1705–10.PubMed

Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993;165:399–404.CrossRefPubMed

Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part III: liver, biliary tract, and pancreas. Gastroenterology. 2009;136:1134–44.CrossRefPubMed

Broomfield PH, Chopra R, Sheinbaum RC, et al. Effects of ursodeoxycholic acid and aspirin on the formation of lithogenic bile and gallstones during loss of weight. N Engl J Med. 1998;319(24):1567–72.CrossRef

10.

Salvioli G, Igimi H, Carey MC. Cholesterol gallstone dissolution in bile: dissolution kinetics of crystalline cholesterol monohydrate by conjugated chenodeoxycholate-lecithin and conjugated ursodeoxycholate-lecithin mixtures—dissimilar phase equilibria and dissolution mechanisms. J Lipid Res. 1983;24:701–20.PubMed

11.

Sarr MG. Patients developed symptomatic gallstones between 3 and 21 months after Roux-en-Y gastric bypass (RYGB), neither prophylactic cholecystectomy nor treatment with ursodeoxycholic acid is necessary after open RYGB. Surg Obes Relat Dis. 2006;2(2):233.CrossRefPubMed

12.

Kim JJ, Schirmer B. Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(1):48–53. https://doi.org/10.1016/j.soard.2008.06.001.CrossRefPubMed

13.

Dorman RB, Zhong W, Abraham AA, et al. Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes? Obes Surg. 2013 Nov;23(11):1718–26. https://doi.org/10.1007/s11695-013-1001-4.CrossRefPubMed

14.

Tucker ON, Fajnwaks P, Szomstein S, et al. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008 Nov;22(11):2450–4. https://doi.org/10.1007/s00464-008-9769-3.CrossRefPubMed

15.

Weiss AC, Inui T, Parina R, et al. Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2015 Nov;29(11):3106–11. https://doi.org/10.1007/s00464-014-4033-5.CrossRefPubMed

16.

Wanjura V, Sandblom G, Österberg J, et al. Cholecystectomy after gastric bypass-incidence and complications. Surg Obes Relat Dis. 2017 Jun;13(6):979–87. https://doi.org/10.1016/j.soard.2016.12.004.CrossRefPubMed

17.

Uy MC, Talingdan-Te MC, Espinosa WZ, et al. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obes Surg. 2008;18:1532–8.CrossRefPubMed

18.

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.CrossRefPubMedPubMedCentral

19.

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011 Available from http://www.cochrane-handbook.org.

20.

Borenstein M, Hedges LV, Higgins JPT, et al. Introduction to meta-analysis. West Sussex: Wiley; 2009. p. 119. 283–287CrossRef

21.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRefPubMed

22.

H.J. GSE. (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]

23.

Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefPubMedPubMedCentral

24.

Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2016; https://doi.org/10.1007/s00595-016-1446-x.

25.

Adams LB, Chang C, Pope J, et al. Randomized, prospective comparison of ursodeoxycholic acid for the prevention of gallstones after sleeve gastrectomy. Obes Surg. 2016;26:990. https://doi.org/10.1007/s11695-015-1858-5.CrossRefPubMed

26.

Coupaye M, Calabrese D, Sami O, et al. Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surg Obes Relat Dis. 2016:00–0. https://doi.org/10.1016/j.soard.2016.11.022.

27.

Miller K, Hell E, Lang B, et al. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238(5):697–702.CrossRefPubMedPubMedCentral

28.

Sugerman HJ, Brewer WH, Shiffman ML, et al. 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;169:91–7.CrossRefPubMed

29.

Williams CN, Gowan R, Perey BJ. A double-blind placebo-controlled trial of ursodeoxycholic acid in the prevention of gallstones during weight loss after vertical banded gastroplasty. Obes Surg. 1993;3:257–9.CrossRefPubMed

30.

Wudel LJ, Wright JK, Debelak JP, et al. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res. 2002;102(1):50–6.CrossRefPubMed

31.

Magouliotis DE, Tasiopoulou VS, Sioka E, et al. Impact of bariatric surgery on metabolic and gut microbiota profile: a systematic review and meta-analysis. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-2595-8.

32.

Caruana JA, McCabe MN, Smith AD, et al. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005;1:564–7.CrossRefPubMed

33.

Papasavas PK, Gagné DJ, Ceppa FA, et al. Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2:41–6.CrossRefPubMed

34.

Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005;1:555–60.CrossRefPubMed

35.

Moon RC, Teixeira AF, Du Coin C, et al. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 2014;10(1):64–8.CrossRefPubMed

Title: Ursodeoxycholic Acid in the Prevention of Gallstone Formation After Bariatric Surgery: an Updated Systematic Review and Meta-analysis
Authors: Dimitrios E. Magouliotis
Vasiliki S. Tasiopoulou
Alexis A. Svokos
Konstantina A. Svokos
Christina Chatedaki
Eleni Sioka
Dimitris Zacharoulis
Publication date: 01-11-2017
Publisher: Springer US
Published in: Obesity Surgery / Issue 11/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2924-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Ursodeoxycholic Acid in the Prevention of Gallstone Formation After Bariatric Surgery: an Updated Systematic Review and Meta-analysis

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

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