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Ursodeoxycholic acid for prevention of gallstone disease after laparoscopic sleeve gastrectomy: an Atlantic Canada perspective

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Prophylactic ursodeoxycholic acid (UDCA) may be beneficial in reducing gallstone disease after bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) 2019 guidelines recommend a 6-month course of UDCA for patients undergoing laparoscopic sleeve gastrectomy (LSG). This has not been adopted broadly. This study intends to assess the effect of routine UDCA administration following LSG on symptomatic gallstone disease.


We performed a retrospective chart review of patients who underwent LSG, between 2009 and 2019, at two tertiary care centers in Atlantic Canada. At one center, UDCA 250 mg oral twice daily was routinely prescribed following LSG for 6 months to patients with an intact gallbladder. At the other center, UDCA was not prescribed. Primary and secondary outcomes were cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) rates. Compliance with and side effects of UDCA therapy were analyzed.


A total of 751 patients were included in the study. Patients who had prior cholecystectomy or were lost to follow up were excluded. After exclusion criteria were applied, 461 patients were included for analysis: 303 in the UDCA group and 158 in the group who did not receive UDCA. Cholecystectomy rate was not significantly associated with UDCA administration, however there was a trend towards less cholecystectomy in patients who received UDCA (8.3% vs. 13.9%, p = 0.056). ERCP rate was significantly lower in patients who received UDCA (0.3% vs 2.5%, p = 0.031). Rate of gallstone disease requiring intervention, either cholecystectomy or ERCP, was significantly decreased in patients who received UDCA (8.9% vs 15.8%, p = 0.022). The most common barriers to compliance with UDCA were cost (45.4%) and nausea (18.1%).


This is the first study to demonstrate lower rates of ERCP in patients receiving routine UDCA following LSG. Our findings support the ASMBS 2019 guidelines for administering UDCA after LSG for preventing gallstone disease.

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  1. Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Chatedaki C, Sioka E, Zacharoulis D (2017) Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: an updated systematic review and meta-analysis. Obes Surg.

    Article  PubMed  Google Scholar 

  2. Sakran N, Dar R, Assalia A, Neeman Z, Farraj M, Sherf-Dagan S, Gralnek I, Hazzan R, Mokary SE, Nevo-Aboody H, Dola T, Kaplan U, Hershko D (2020) The use of ursolit for gallstone prophylaxis following bariatric surgery: a randomized-controlled trial. Updates Surg.

    Article  PubMed  Google Scholar 

  3. Adams LB, Chang C, Pope J, Kim Y, Liu P, Yates A (2016) Randomized, prospective comparison of ursodeoxycholic acid for the prevention of gallstones after sleeve gastrectomy. Obes Surg.

  4. Talha A, Abdelbaki T, Farouk A, Hasouna E, Azzam E, Shehata G (2020) Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial. Surg Endosc.

    Article  PubMed  Google Scholar 

  5. Boerlage TC, Haal S, Maurits de Brauw L, Acherman YI, Bruin S, van de Laar AW, Moes DE, van Wagensveld BA, de Vris CE, van Veen R, Schouten R, Dijkgraff MG, Fockens P, Gerdes VE, Voermans RP (2017) Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery: study protocol for a randomized controlled trial (UPGRADE trial). BMC Gastroenterol.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Salman MA, Salman A, Mohamed US, Hussein AM, Ameen MA, Omar HS, Elewa A, Hamdy A, Elias AA, Tourky M, Helal A, Mahmoud AA, Aljarad F, Moustafa A, Shaaban HE, Nashaat A, Husseun AM, Omar T, Balamoun H (2022) Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study. Surg Endosc.

    Article  PubMed  Google Scholar 

  7. Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P (2009) Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc.

    Article  PubMed  Google Scholar 

  8. Csendes A, Csendes P, Orellana O, Cuneo N, Figueroa M, Martinez G (2019) Patients remain at high risk of gallstones development late (10 y) after sleeve gastrectomy? Surg Laparosc Endosc Percutan Tech.

    Article  PubMed  Google Scholar 

  9. Sioka E, Zacharoulis D, Zachari E, Papamargaritis D, Pinaka O, Katsogridaki G, Tzovaras G (2014) Complicated gallstones after laparoscopic sleeve gastrectomy. J Obes.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD (2020) Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surgery for Obesity and Related Diseases.

  11. Coupaye M, Calabrese D, Sami O, Msika S, Ledoux S (2017) Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surg Obes Relat Dis.

    Article  PubMed  Google Scholar 

  12. Sugerman H, Brewer WH, Shiffman ML, Brolin RE, Fobi MA, Linner HJ, MacDonald KG, MacGregor AM, Martin LF, Oram-Smith JC (1995) 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.

    Article  PubMed  Google Scholar 

  13. Hempfling W, Dilger K, Beuers U (2003) Systematic review: ursodeoxycholic acid–adverse effects and drug interactions. Aliment Pharmacol Ther.

    Article  PubMed  Google Scholar 

  14. Paumgartner G, Beuers U (2004) Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease. Clin Liver Dis.

    Article  PubMed  Google Scholar 

  15. Wudel LJ, Wright JK, Debelak JP, Allos TM, Shyr Y, Chapman WC (2002) Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res.

    Article  PubMed  Google Scholar 

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Correspondence to Bradley Evans.

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Dr. Intekhab Hossain, Dr. Jane Brodie, Erin O’Brien, Dr. Katherine Tedman-Aucoin, Diana Lawlor, Raleen Murphy, Dr. Laurie Twells, Dr. David Pace, Dr. James Ellsmere, and Dr. Bradley Evans have no conflicts of interest or financial ties to disclose.

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Hossain, I., Brodie, J., O’Brien, E. et al. Ursodeoxycholic acid for prevention of gallstone disease after laparoscopic sleeve gastrectomy: an Atlantic Canada perspective. Surg Endosc 37, 5236–5240 (2023).

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