Usufulness of Ursodeoxycholic Acid for the Prevention of Gallstones and Its Complications in Patients Undergoing Gastric Bypass
DOI:
https://doi.org/10.52787/agl.v52i1.138Keywords:
Obesity, gastric bypass, gallstones, ursodeoxycholic acidAbstract
Introduction. Rapid weight loss after bariatric surgery is a risk factor for the development of gallstones and its complications. The administration of ursodeoxycholic acid could be a preventive alternative.
Aim. To compare the incidence of gallstones in patients treated and not treated with ursodeoxycholic acid and, secondarily, to evaluate the rate of cholecystectomy in each group.
Materials and methods. An observational, retrospective cohort study of two non-randomized populations of patients undergoing gastric bypass surgery. The first population was collected retrospectively and the second prospectively and consecutively. Group 1 (without intervention) underwent surgery between January 2016 and December 2018 and did not receive medication, and group
2 (with intervention): operated between May 2019 and October 2020, to whom ursodeoxycholic acid was administered at 600 mg/day for six months. In all cases, abdominal ultrasound was performed at six and twelve months after surgery.
Results. In group 1 (n = 73), 21 patients (28.7%) presented an ultrasound finding of gallstones at 6 months, 2 at 12 months (2.73%), for a total of 23 patients (31.5%). In group 2 (n = 32), 4 patients (12.5%) presented a diagnosis of gallstones in the first follow-up period and 1 case in the second, for a total of 5 patients (p = 0.067). Eighteen cholecystectomies were performed due to clinical manifestations related to gallbladder pathology: 17 cases in Group 1 (24.65%) and 1 in Group 2 (3.12%), with a statistically significant difference (p ≤ 0,0435).
Conclusion. We have observed a lower incidence of gallstones in the group that received ursodeoxycholic acid, which was clinically relevant, without reaching statistically significant differences. On the other hand, a significant decrease was observed in the number of cholecystectomies one year after bariatric surgery.
References
- 1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, y cols. Resumen ejecutivo: estadísticas de enfermedades cardíacas y accidentes cerebrovasculares - Actualización de 2013. American Heart Association. Circulación. 2013;127(1):143-52.
- 2. Paumgartner G, Sauerbruch T. Gallstones: pathogenesis. Lancet. 1991;338(8775):1117-21.
- 3. Jonas E, Marsk R, Rasmussen F, Freedman J. Incidence of postoperative gallstone disease after antiobesity Surgery: population-based study from Sweden. Surg Obes Relat Dis. 2010;6(1):54-8.
- 4. Shiffman ML, Sugerman HJ, Kellum JM, Brewer WH, Moore EW. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86(8):1000-5.
- 5. Plecka Östlund M, Wenger U, Mattsson F, Ebrahim F, Botha A, Lagergren J. Population - based study of the need for cholecystectomy after obesity surgery. Br J Surg. 2012;99(6):864-9.
- 6. Magouliotis DE, Tasiopoulou VS, Sioka E, Zacharoulis D. Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: A systematic review and meta-analysis. Obes Surg. 2017;27(1):245-53.
- 7. Shiffman ML, Sugerman HJ, Kellum JM, Moore EW. Changes in gallbladder bile composition following gallstone formation and weight 12 reduction. Gastroenterology. 1992;103(1):214-21.
- 8. Kumaravel A, Zelisko A, Schauer P, López R, Kroh M, Stevens T. Acute pancreatitis in patients after bariatric surgery: incidence, outcomes, and risk factors. Obes Surg. 2014;24(12):2025-30.
- 9. Choi EK, Chiorean MV, Coté GA, El Hajj II, Ballard D, Fogel EL, et al. ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery. Surg Endosc. 2013;27(8):2894-9.
- 10. Uy MC, Talingdan-Te MC, Espinosa WZ, Daez MLO, Ong JP. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obes Surg. 2008;18(12):1532-8.
- 11. Mangeaud A, Elías Panigo DH. 2018 R-Medic. Un programa de análisis estadísticos sencillo e intuitivo. Revista Methodo 3. 2018;(1):18-22.
- 12. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev. 2009;(2):CD003641.
- 13. Malone M, Lindstrom J, Gallati C. Impact of change in duration of therapy with Ursodiol after gastric bypass surgery. Pharmacotherapy. 2011;31(10):315e.
- 14. Magouliotis DE, Tasiopoulou VS, Sioka E, Chatedaki C, Zacharoulis D. Impact of bariatric surgery on metabolic and gut Microbiota profile: A systematic review and meta-analysis. Obes Surg. 2017;27(5):1345-57.
- 15. Moon RC, Teixeira AF, DuCoin C, Varnadore S, Jawad MA. Comparison of cholecystectomy cases after Rouxen-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 2014;10(1):64-8.
- 16. Coupaye M, Calabrese D, Sami O, Siauve N, Ledoux S. Effectiveness of ursodeoxycholic acid in the prevention of cholelithiasis after sleeve gastrectomy. Obes Surg. 2019;29(8):2464-9.
- 17. Adams LB, Chang C, Pope J, Kim Y, Liu P, Yates A. Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy. Obes Surg. 2016;26(5):990-4.
- 18. Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017;47(7):844-50.
- 19. Caruana JA, McCabe MN, Smith AD, Camara DS, Mercer M, Gillespie JA. Incidence of symptomatic gallstones after gastric bypass: Is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005;1(3):229.
- 20. Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005;1(6):555-60.
- 21. 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.
- 22. 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.
- 23. Sarr MG. Patients developed symptomatic gallstones between 3 and 21 months after Roux-en-Y gastric bypass (RYGB), neither prophylactic cholecystectomy nor treatment with ursodeoxycholic acid is necessary after open RYGB. Surg Obes Relat Dis. 2006;2(2):233; author reply 233.
- 24. 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
- 25. Wanjura V, Sandblom G, Österberg J, Enochsson L, Ottosson J, Szabo E. Cholecystectomy after gastric bypass-incidence and complications. Surg Obes Relat Dis. 2017;13(6):979-87.
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