Risk Factors for Symptomatic Gallstone Disease and Gallstone Formation After Bariatric Surgery

Abstract

Purpose Patients who undergo bariatric surgery are at risk for developing cholesterol gallstones. We aimed to identify risk factors that are associated with symptomatic gallstone disease and gallstone formation after bariatric surgery. Materials and Methods We included participants of the UPGRADE trial, a multicenter randomized placebo-controlled trial on the prevention of symptomatic gallstone disease with ursodeoxycholic acid (UDCA) after bariatric surgery. The association between patient characteristics and symptomatic gallstone disease, and gallstone formation was evaluated using logistic regression analysis. Results Of 959 patients, 78 (8%) developed symptomatic gallstone disease within 24 months. Risk factors were the presence of a pain syndrome (OR 2.07; 95% CI 1.03 to 4.17) and asymptomatic gallstones before surgery (OR 3.15; 95% CI 1.87 to 5.33). Advanced age (OR 0.95; 95% CI 0.93 to 0.97) was protective, and UDCA prophylaxis did not reach statistical significance (OR 0.64; 95% CI 0.39 to 1.03). No risk factors were identified for gallstone formation, whereas advanced age (OR 0.98; 95% CI 0.96 to 1.00), statin use (OR 0.42; 95% CI 0.20 to 0.90), and UDCA prophylaxis (OR 0.47; 95% CI 0.30 to 0.73) all reduced the risk. Conclusion Young patients with a preoperative pain syndrome and/or asymptomatic gallstones before bariatric surgery are at increased risk for symptomatic gallstone disease after surgery. Whether statins, either alone or in combination with UDCA prophylaxis, can further reduce the burden of gallstones after bariatric surgery should be investigated prospectively. Graphical abstract

Incidence and risk factors for cholelithiasis after bariatric surgery: a systematic review and meta-analysis

“…Caucasians were defined as exposed, and other races were defined as nonexposed. Three articles evaluated whether race is a risk factor for cholelithiasis after bariatric surgery [ 20 , 24 , 30 ] There was no heterogeneity among the studies (I 2 = 0%, P = 0.84), so a fixed-effects model was used for the meta-analysis. The results showed that white race was a risk factor for cholelithiasis after bariatric surgery [OR = 1.62, 95% CI (1.19, 2.19), P = 0.002].…”

“…This research examined two surgical procedures, RYGB and SG, and defined RYGB as exposure and SG as nonexposure. A total of 10 articles [ 16 – 20 , 23 , 25 , 30 – 32 ] investigated whether the surgical procedure is a risk factor for cholelithiasis after bariatric surgery. There was moderate heterogeneity (I 2 = 66%, P = 0.002), so a random-effect model was used for the meta-analysis.…”

“…After reviewing the literature, it was found that the article by Vicky Ka Ming Li [ 23 ] divided patients into %TWL > 25% and %TWL < 25% according to %TWL. The two studies published by Sylke Haal in 2019 and 2022 [ 20 , 21 ] calculated ORs by regression analysis, so exposure was not defined, which may be the cause of heterogeneity. In addition, the study of Sylke Haal 2019 [ 21 ] included only the RYGB procedure, while the study of Sylke Haal 2022 [ 20 ] included both RYGB and SG procedures, and the study of Vicky Ka Ming Li also included the AGB procedure, which may also be a source of heterogeneity.…”

Research progress on the immune microenvironment of the gallbladder in patients with cholesterol gallstones

“…Insufficient gallbladder motility contributes to cholesterol gallstone formation and is impaired under many risk factors for cholesterol gallstone formation, such as pregnant women, obese patients, and their rapid weight loss, diabetes mellitus, and patients receiving total parenteral nutrition[ 63 ]. A recent study showed that 78 of 959 patients (8%) who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy developed symptomatic gallstone disease within 24 mo[ 64 ]. In patients without gallstones before RYGB surgery, ursodeoxycholic acid treatment reduced the occurrence of symptomatic gallstone disease compared with placebo[ 65 ].…”

Microbiota analysis with next-generation 16S rDNA gene sequencing in recurrent common bile duct stones

“…The recurrence rates of common bile duct (CBD) stones vary across different studies, but range from 4-24% (4). Research has confirmed that the reasons for gallstone formation are aberrant metabolism and the secretion of cholesterol and bile acids (5). Currently, a sphincter of Oddi laxity (SOL) is considered an important factor in cholangiolithiasis occurrence.…”