The Relationship Between Ursodeoxycholic Acid (Ursobil) Administration and the Prevention of Gallstone Formation After Bariatric Surgery

Document Type : Original Article (s)

Authors

1 Laparascopic and Bariatric Surgery Fellowship, School of Medicien, Isfahan University of Medical Sciences, Isfahan, Iran

2 General Practitioner, School of Medicien, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Bariatric surgeries are accompanied by problems such as gallstone formation following the rapid weight loss after the surgery. This retrospective cohort research intended to study the relationship between Ursodeoxycholic acid (UDCA) administration and prevention of gallstone formation after three types of bariatric surgery.
Methods: In this cohort study, 444 patients who underwent bariatric surgery in Al-Zahra and Sina Hospitals between March 2019 and August 2020 were divided into group A (UDCA-treated patients) and group B (untreated patients). The patients followed up six months after the surgery through gallbladder ultrasonography. In addition, Body mass index (BMI) values were recorded before and after the surgery. Data analysis was done using Chi-square and Poisson regression tests.
Findings: Half of the 444 patients (50%) received UDCA. The follow-up ultrasound showed that gallstones had formed in sixteen (7.2%) of the patients in group A and 45 (20.27%) in group B. There was an indirect relationship between the rapid decline of BMI and the formation of gallstones following bariatric surgery.
Conclusion: According to findings from this research, the patients who received a prophylactic dose of UDCA post-bariatric surgery in various doses showed lower gallstone formation than those who didn’t receive UDCA medication.

Keywords

Main Subjects


  1. Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy ongallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol 1993; 88(10): 1705-10.
  2. Wudel Jr LJ, Wright JK, Debelak JP, Allos TM, Shyr Y, Chapman WC. 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.
  3. Miller K, Hell E, Lang B, Lengauer E. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: a randomized double-blind placebo-controlled trial. Ann SurgAnnals of surgery. 2003 Nov; 238(5): 697-702.
  4. Paumgartner G, Sauerbruch T. Gallstones: pathogenesis. Lancet 1991; 338(8775): 1117-21.
  5. Shiffman ML, Sugerman HJ, Kellum JM, Moore EW. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology 1992; 103(1): 214-21.
  6. Kumaravel A, Zelisko A, Schauer P, Lopez R, Kroh M, Stevens T. Acute pancreatitis in patients after bariatric surgery: incidence, outcomes, and risk factors. Obes Surg 2014; 24(12): 2025-30.
  7. 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(1): 91-7.
  8. Worni M, Guller U, Shah A, Gandhi M, Shah J, Rajgor D, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to2008. Obes Surg 2012; 22(2): 220-9.
  9. D'Hondt 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.
  10. Li VKM, 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 2009; 23(7): 1640-4.
  11. Yang H, Petersen GM, Roth MP, Schoenfield LJ, Marks JW. Risk factors for gallstone formation during rapid loss of weight. Dig Dis Sci 1992; 37(6): 912-8.
  12. Chelikani PK, Sekhar D. Sleeve gastrectomy: mechanisms of weight loss and diabetes improvements. InMetabolism and Pathophysiology of Bariatric Surgery: Nutrition, Procedures, Outcomes and Adverse Effects 2017 (pp. 295-303). Elsevier Inc.
  13. Abdallah E, Emile SH, Elfeki H, Fikry M, Abdelshafy M, Elshobaky A, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today 2017; 47(7): 844-50.
  14. Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Chatedaki C, Sioka E, et al. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: an updated systematic review and meta-analysis. Obes Surg 2017; 27(11): 3021-30.
  15. Coupaye M, Calabrese D, Sami O, Msika S, Ledoux S. Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surg Obes Relat Dis 2017; 13(4): 681-5.
  16. Broomfield PH, Chopra R, Sheinbaum RC, Bonorris GG, Silverman A, Schoenfield LJ, et al. Effects of ursodeoxycholic acid and aspirin on the formation of lithogenic bile and gallstones during loss of weight. N Engl J Med 1988; 319(24): 1567-72.
  17. Uy MC, Talingdan-Te MC, Espinosa WZ, Daez ML, Ong JP. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obes Surg 2008; 18(12): 1532-8.