Ursodeoxycholic Acid Prevents Gallstones After Gastric Restrictive Procedures

Laurie Barclay, MD

November 07, 2003

Nov. 7, 2003 — Daily ursodeoxycholic acid for six months was effective prophylaxis against gallstone formation after gastric restrictive procedures, according to the results of a randomized, double-blind, placebo-controlled trial published in the November issue of the Annals of Surgery.

"Rapid weight loss after surgery for the treatment of morbid obesity is associated with a high incidence of gallstone formation," write Karl Miller, MD, from Krankenhaus Hallein in Austria, and colleagues. "Ursodeoxycholic acid (600 mg/d) is highly effective in preventing gallstone formation in patients undergoing dietary-induced weight reduction."

From March 1997 to April 2000, 262 patients with morbid obesity had vertical banded gastroplasty or adjustable gastric banding at a single-center. Of these, 77 patients refused to participate in the study, and 43 patients with previous gallstone operation or gallstones verified preoperatively were excluded.

Of 152 patients enrolled in the study, 76 were randomized to placebo and 76 to 500 mg of ursodeoxycholic acid daily, beginning within three days after surgery and continuing for six months or until gallstone development was documented on transabdominal sonography or abdominal computed tomography.

Both groups were similar in sex, preoperative age, weight, and body mass index, and in postoperative weight loss. Compared with the placebo group, patients in the ursodeoxycholic acid group had less gallstone formation at 12 months (3% vs. 22%; P = .0018) and at 24 months (8% vs. 30%; P = .0022). They also had lower rates of cholecystectomy (4.7% vs. 12%; P < .02), which was performed an average of 14.9 ± 4.3 months after bariatric surgery.

"A daily dose of 500 mg of ursodeoxycholic acid in divided doses semi-daily for six months is an effective prophylaxis for gallstone formation after gastric restrictive procedures and avoids simultaneous cholecystectomy in morbidly obese patients," the authors write. "The question remains of how long ursodeoxycholic acid should be taken and how effective this drug is in long-term weight loss."

Ann Surg. 2003;238: 697-702

Reviewed by Gary D. Vogin, MD