Risk Factors for Symptomatic Gallstone Disease and Gallstone Formation After Bariatric Surgery

• Published in: Obesity surgery Vol. 32; no. 4; pp. 1270 - 1278
• Main Authors: Haal, Sylke, Guman, Maimoena S. S., Bruin, Sjoerd, Schouten, Ruben, van Veen, Ruben N., Fockens, Paul, Dijkgraaf, Marcel G. W., Hutten, Barbara A., Gerdes, Victor E. A., Voermans, Rogier P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2022; Springer Nature B.V
• Subjects: Asymptomatic; Bariatric Surgery - adverse effects; Disease prevention; Gallstones; Gallstones - epidemiology; Gallstones - etiology; Gallstones - prevention & control; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Risk Factors; Surgery; Ursodeoxycholic Acid - therapeutic use; Symptomatic gallstone disease; Risk factors; Gallstone formation
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-022-05947-8

Purpose Patients 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 Methods We 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. Results Of 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. Conclusion Young 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