The impact of ursodeoxycholic acid on gallstone disease after bariatric surgery: a meta-analysis of randomized control trials

Fearon, Naomi; Kearns, Emma; Kennedy, Czara; Conneely, John B.; Heneghan, Helen

doi:10.1016/j.soard.2021.10.004

Cited by 17 publications

(6 citation statements)

References 42 publications

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“…1,3,6,7 A delay in presentation could be explained by the tumbling phenomenon, which describes the intermittent course of symptoms caused by temporary stone impaction followed by dislodgement of the stone, which then travels distally and re-impacts. 3,6,8 Similarly to the present case (concomitant GOO and SBO), GSI should be suspected in patients presenting with SBO and having a history of gallbladder stones (a well-known risk factor). 5 Rigler's triad is comprised of the following imaging findings suggestive of GSI: bowel obstruction, pneumobilia, a radioopaque shadow within the bowel lumen (ectopic gall stones), and, more recently, a change in gallstone position on serial abdominal X-rays.…”

Section: Discussionmentioning

confidence: 61%

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

Alali,

Alshehri,

Ahmad

et al. 2023

Int Surg J

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Gallstone ileus and Bouveret's syndrome are rare gallstone complications; therefore, their combination is even rarer. The delay of diagnosis is associated with high rates of morbidity and mortality. We reported a 65-year-old woman presented with a three-day history of epigastric and lower right abdominal pain, nausea, and vomiting. A radiopaque shadow was noted on an abdominal X-ray in both the right upper and lower quadrants. In addition to the cholecysto-duodenal fistula, the CT abdomen revealed a combined ileal gallstone ileus with small bowel dilatation and stone in the second portion of the duodenum (Bouveret's syndrome). Initial attempts to extract duodenal stones endoscopically were unsuccessful. Therefore, the patient underwent an exploratory laparotomy and removal of both ileal and duodenal stones. The patient had an uneventful postoperative course. Serious complications include obstruction of the gastric outlet or the small intestine due to gallstone ileus, Bouveret's syndrome, or both. Despite the high failure rate, endoscopic extraction of the stone alone or in combination with lithotripsy is the standard treatment for Bouveret's syndrome. Furthermore, surgical intervention is the standard treatment for gallstone ileus. Gallstone ileus and Bouveret's syndrome remain diagnostic and therapeutic challenges, which necessitate an immediate multidisciplinary approach to prevent substantial morbidity and mortality. Further reports or larger-scale studies are encouraged.

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Section: Discussionmentioning

confidence: 61%

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

Alali,

Alshehri,

Ahmad

et al. 2023

Int Surg J

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“…There are many original studies exploring the risk factors for cholelithiasis after bariatric surgery, but regarding conclusions, in addition to the current evidence suggesting that UDCA can prevent the occurrence of postoperative cholelithiasis [ 33 – 36 ], it is difficult to reach consensus on other factors. The results of this study show that Caucasians and women are risk factors for cholelithiasis after bariatric surgery; surgical procedure, BMI, weight loss, hypertension, diabetes mellitus, dyslipidemia, and smoking are not risk factors for concurrent postoperative cholelithiasis.…”

Section: Discussionmentioning

confidence: 99%

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

Dai

Luo

2023

Lipids Health Dis

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Background Obesity has been identified as an independent risk factor for cholelithiasis. As a treatment for obesity, bariatric surgery may increase the incidence of cholelithiasis. The risk factors for cholelithiasis after bariatric surgery remain uncertain. The purpose of this study was to explore the risk factors for postoperative cholelithiasis after weight-loss surgery and propose suggestions for clinical decision making. Methods Four databases, PubMed, EMBASE, Web of Science and Cochrane, were systematically searched for all reports about cholelithiasis after bariatric surgery, and literature screening was performed following prespecified inclusion criteria. The included studies were all evaluated for quality according to the NOS scale. Data extraction was followed by analysis using Reviewer Manager 5.4 and StataSE 15. Results A total of 19 articles were included in this meta-analysis, and all studies were of high quality. A total of 20,553 patients were included in this study. Sex [OR = 0.62, 95% CI (0.55, 0.71), P < 0.00001] and race [OR = 1.62, 95% CI (1.19, 2.19), P = 0.002] were risk factors for cholelithiasis after bariatric surgery. Surgical procedure, preoperative BMI, weight-loss ratio, smoking, hypertension, diabetes mellitus, and dyslipidemia were neither protective nor risk factors for cholelithiasis after bariatric surgery. Conclusion Caucasian race and female sex are risk factors for developing cholelithiasis after bariatric surgery; surgical procedure, BMI, weight loss ratio, hypertension, diabetes mellitus, dyslipidemia, and smoking are not risk factors for cholelithiasis after bariatric surgery.

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“…While some RCTs found that prophylactic administration of UDCA is associated with reduced gall stones [28,29], the RCT conducted by Wudel et al revealed UDCA has no preventive role [22]. There are some meta-analyses performed to identify the role of UDCA in preventing gallstones after bariatric surgery, but these meta-analyses included retrospective studies, prospective studies, and RCTs [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Such efforts include prophylactic cholecystectomy during bariatric surgery [14,17,18]. Others include the administration of ursodeoxycholic acid (UDCA) after the surgery to reduce the risk of gallstone formation and cholecystectomy with its attending complications [19][20][21]. There have been studies assessing the role of UDCA prophylaxis in preventing gallstone formation with conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Ursodeoxycholic Acid Prophylaxis and the Reduction of Gallstone Formation After Bariatric Surgery: An Updated Meta-Analysis of Randomized Controlled Trials

Al-huniti,

Alsardi,

Odeh

et al. 2023

Cureus

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Gallstone formation following bariatric surgery poses a significant clinical concern, prompting various preventive strategies, including ursodeoxycholic acid (UDCA) prophylaxis. This systematic review and metaanalysis aimed to assess the efficacy of UDCA in preventing gallstone formation after bariatric surgery.A comprehensive literature search was conducted in major databases up to September 2023, identifying 12 randomized controlled trials (RCTs) meeting the inclusion criteria. The studies, spanning from 1993 to 2022, involved 2,767 patients who underwent diverse bariatric procedures. The primary outcome was the overall incidence of cholelithiasis, with secondary outcomes encompassing gallstone occurrences at three, six, and 12 months; symptomatic cholelithiasis; and rates of cholecystectomy. The Cochrane risk-of-bias tool was utilized for evaluating study quality, and statistical analyses were conducted using the RevMan software (Cochrane Collaboration, London, UK).Patients receiving UDCA demonstrated a significantly lower overall incidence of gallstones post-bariatric surgery (risk ratio [RR] 0.13; P < 0.0001). Subgroup analyses confirmed reduced gallstone incidence at three months (P = 0.04), six months (P < 0.00001), and one year (P < 0.00001) with UDCA prophylaxis. Symptomatic cholelithiasis incidence was also lower in the UDCA group (RR 5.70; P < 0.00001), and cholecystectomy rates were significantly reduced (RR 3.05; P = 0.002).This meta-analysis supports the efficacy of UDCA prophylaxis in preventing gallstone formation after bariatric surgery. The findings suggest that UDCA administration not only lowers overall gallstone incidence but also reduces the occurrence of symptomatic cholelithiasis and mitigates the need for cholecystectomy. However, caution is warranted due to heterogeneity, diverse surgical procedures, and limited long-term follow-up in the included studies. Further research with standardized protocols and extended observational periods is recommended to strengthen the evidence base and guide clinical practice.

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The impact of ursodeoxycholic acid on gallstone disease after bariatric surgery: a meta-analysis of randomized control trials

Cited by 17 publications

References 42 publications

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

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

Ursodeoxycholic Acid Prophylaxis and the Reduction of Gallstone Formation After Bariatric Surgery: An Updated Meta-Analysis of Randomized Controlled Trials

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