Ursodeoxycholic Acid in the Prevention of Gallstone Formation after Bariatric Surgery: A Meta-analysis
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Rapid weight loss increases risk for gallstone formation. Prophylactic cholecystectomy is difficult. Several small trials have shown that ursodeoxycholic acid (UDCA) may prevent gallstone formation after bariatric surgery. The aim of this study is to assess the efficacy and safety of UDCA in the prevention of gallstone formation after bariatric surgery.
Electronic databases, including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Australasian Medical Index, LILACS, and HERDIN, were searched. Reference lists of trials selected by the above electronic searching were also searched. Authors of the retrieved trials and pharmaceutical companies were also contacted for other trials, published and unpublished. A meta-analysis of all randomized, double-blind, placebo-controlled prospective trials comparing UDCA and placebo was performed.
Five RCTs including 521 patients were assessed. Random effects meta-analysis showed a significant reduction of gallstone formation (RR 0.43, 95% confidence interval 0.22–0.83), with 8.8% of those taking UDCA developing gallstones compared to 27.7% for placebo. Although this meta-analysis is heterogeneous with I 2 of 61.9%, the directions of the effect are all consistently in favor of UDCA (p = 0.01). A meta-analysis on the adverse effects could not be performed because the studies did not report them in a way to make the analysis possible.
UDCA can prevent gallstone formation after bariatric surgery.
- 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. CrossRef
- 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.
- 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. CrossRef
- 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. CrossRef
- The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions 4.2.6. updated September 2006.
- 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. CrossRef
- Taylor J, Leitman M, Horowitz M. Is routine cholecystectomy necessary at the time of roux-en-y gastric bypass? Obes Surg. 2006;16:759–61. CrossRef
- Fuller W, Rasmussen JJ, Ghosh J, Ali MR. Is routine cholecystectomy indicated for asymptomatic cholelithiasis in patients undergoing gastric bypass? Obes Surg. 2007;17:747–51. CrossRef
- Scott DJ, Villegas L, Sims TL, Hamilton EC, Provost DA, Jones DB. Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass. Surg Endosc. 2003;17:1796–802. CrossRef
- Shiffman ML, Kaplan GD, Brinkman-Kaplan V, et al. Prophylaxis against gallstone formation with ursodeoxycholic acid in patients participating in a very-low-calorie diet program. Ann Int Med. 1995;122(12):899–905.
- Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724–37. CrossRef
- 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.
- Lafferrere B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16. CrossRef
- Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. Philadelphia: Saunders Elsevier; 2006.
- Tan-Tin Hay LM, Oliveros E, Esguerra E, et al. A review of the metabolic profile of patients undergoing bariatric surgery in St. Luke’s Medical Center (2002–2004). Philipp J Int Med. 2005;43:323–30.
- Ursodeoxycholic Acid in the Prevention of Gallstone Formation after Bariatric Surgery: A Meta-analysis
Volume 18, Issue 12 , pp 1532-1538
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