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

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Abstract

The aim of this meta-analysis was to assess whether treatment with ursodeoxycholic acid (UDCA) in patients who have undergone bariatric surgery reduces gallstone formation. A systematic literature search was performed using electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar and the WHO International Clinical Trials Registry platform). RCTs without restrictions on study language, year, status of publication and patient’s age were used. Pooled risk ratios were calculated using a random-effects model. Subgroup analyses for drug dose, duration and procedure types were performed. Sensitivity analyses and a summary of findings table were generated to assess the robustness and the level of evidence provided, respectively. Fourteen trials were included (3619 patients, 2292 in UDCA vs 1327 in control group). Procedures included SG, RYGB, OAGB, AGB and Gastroplasty. UDCA dose ranged from 300 to 1200 mg per day. Gallstone formation occurred in 19.3% (8.3% in UDCA vs 38.1% in the control group). UDCA significantly reduced the risk of gallstone formation (14 trials, 3619 patients; RR 0.27, 95% CI 0.18–0.41; P < 0.001). UDCA significantly reduced the risk of symptomatic gallstone disease (6 trials, 2458 patients; RR 0.30, 95% CI 0.21–0.43; P < 0.001). No subgroup difference was found for different doses, duration and type of procedure performed. Oral UDCA treatment significantly reduces the risks of developing gallstones in postoperative bariatric patients from 38 to 8%. The use of 500 to 600 mg UDCA for 6 months is effective and should be implemented in all patients post-bariatric surgery.

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Data Availability

The authors declare that all relevant data used to conduct this review are included in the manuscript and supplements. Data is available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. St. Peter’s Hospital, Guildford Rd, Lyne, Chertsey, Surrey, KT16 0PZ, UK

    Amit Sharma

  2. University College London, London, UK

    Amit Sharma & Lawrence M. J. Best

  3. Kings College Hospital, London, UK

    Hiba Shanti & Ameet G. Patel

  4. Aneurin Bevan University Health Board, Newport, Abercynon, UK

    Haritharan Nageswaran

  5. Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, Oxfordshire, UK

    Lawrence M. J. Best

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Presented as an oral abstract at the UGI Congress, Belfast, UK, October 2021

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Sharma, A., Shanti, H., Nageswaran, H. et al. Role of Ursodeoxycholic Acid in the Prevention of Gallstones Formation in Bariatric Patients—a Systematic Review and Meta-Analysis of Randomised Trials. OBES SURG 33, 4115–4124 (2023). https://doi.org/10.1007/s11695-023-06893-9

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  • DOI: https://doi.org/10.1007/s11695-023-06893-9

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