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

Abstract

Gallstone formation following bariatric surgery poses a significant clinical concern, prompting various preventive strategies, including ursodeoxycholic acid (UDCA) prophylaxis. This systematic review and meta-analysis 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.

Keywords: bariatric surgery; cholecystectomy rates; gallstone formation; meta-analysis; ursodeoxycholic acid prophylaxis.

Figure 1. Study selection process.

Figure 2. Meta-analysis of the overall incidence of gallstones after bariatric surgery.

Wudel et al. [22], Worobetz et al. [23], Talha et al. [24], Adams et al. [26], Abouzeid and Shoka [27], Pizza et al. [28], Sugerman et al. [29], Miller et al. [30], Tamer et al. [31], Sakran et al. [32], Williams et al. [33], Salman et al. [34] UDCA, ursodeoxycholic acid; CI, confidence interval

Figure 3. Meta-analysis of incidence of gallstones after bariatric surgery at (A) three months, (B) six months, and (C) one year after surgery.

Worobetz et al. [23], Sugerman et al. [29], Pizza et al. [28]. Sugerman et al. [29], Adams et al. [26], Abouzeid and Shoka [27], Pizza et al. [28], Sakran et al. [32]. Miller et al. [30], Abouzeid and Shoka [27], Talha et al. [24], Tamer et al. [31], Pizza et al. [28], Salman et al. [34]. UDCA, ursodeoxycholic acid; CI, confidence interval

Figure 4. Meta-analysis of the incidence of (A) symptomatic gallstones after bariatric surgery and (B) the rate of cholecystectomy after surgery.

Worobetz et al. [23], Talha et al. [24], Pizza et al. [28]. Worobetz et al. [23], Miller et al. [30], Pizza et al. [28], Salman et al. [34].