Abstract
PurposePatients 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 MethodsWe 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.ResultsOf 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.ConclusionYoung 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
Highlights
Rapid weight loss after bariatric surgery is a major risk factor for cholesterol gallstone disease [1]
ursodeoxycholic acid (UDCA) prophylaxis does not seem to be indicated, since we have shown that it did not reduce the occurrence of symptomatic gallstone disease in these patients [41]
In line with several other studies who have shown that advanced age decreases the risk on cholecystectomy after bariatric surgery [30, 31, 36, 37], we have found that older patients have a decreased risk on symptomatic gallstone disease and gallstone/sludge formation
Summary
We aimed to identify risk factors that are associated with symptomatic gallstone disease and gallstone formation after bariatric surgery. The purpose of this study was to investigate associations between patient characteristics and symptomatic gallstone disease, and gallstone formation after bariatric surgery using data from the UPGRADE trial, a large randomized placebocontrolled trial [40, 41]
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