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Prevention of Gallstone Formation in Morbidly Obese Patients Undergoing Rapid Weight Loss: Results of a Randomized Controlled Pilot Study
Abstract
Introduction An increased risk of gallstone (GS) formation has been linked to obesity and to episodes of rapid and significant weight loss. Previous reports have suggested that bile salt therapy (ursodeoxycholic acid) or prostaglandin inhibition (ibuprofen) may prevent gallstone formation in this high-risk group. The purpose of this study was to investigate GS prevention following bariatric surgery. Design Randomized double blind controlled trial. Methods Sixty patients without gallstones preoperatively (gender, 9 male, 51 female; average preop wt, 349.6 lb; mean age, 38 years) were randomly assigned to receive urso (600 mg/day, n = 20), ibuprofen (600 mg/d, n = 20), or placebo (n = 20). At the time of standard open gastric bypass, intraoperative ultrasonography confirmed the absence of stones or microcalculi, and bile samples were collected via puncture of the gallbladder for bile lipid analysis. Following recovery and resumption of a bariatric diet, study medication was prescribed for the first 6 months postop. Gallbladder emptying and GS formation were assessed using ultrasonograms preop and at 3, 6, 9, and 12 months postop (gallbladder emptying following a high-fat liquid test meal was assessed preop, and at 3 and 6 months postop). Results Forty-one (68.3%, 8 male, 33 female) of the original 60 patients completed all phases of the study (15 urso, 15 ibuprofen, 11 placebo). The average weight loss was 98.5 +/- 7.2 lb over the 12-month period following bariatric surgery. Tw…
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The moderate overall compliance of 63% in our trial is consistent with compliance rates reported in other trials.
“The moderate overall compliance of 63% in our trial is consistent with compliance rates reported in other trials, 6,8,35,36 although higher rates have been reported as well.7,25,37,38”
In prospective randomized studies, prophylactic administration of ursodeoxycholic acid has been shown to be effective in gastric bypass procedures, as well as in a small series with vertical banded gastroplasty.
“In prospective randomized studies, the prophylactic administration of ursodeoxycholic acid has been shown to be effective in gastric bypass procedures20–22, as well as in a small series with vertical banded gastroplasty.23”
From Gallstone Formation Prophylaxis After Gastric Restrictive Procedures for Weight Loss: A Randomized Double-Blind Placebo-Controlled Trial (2003) · cites this paper as [22]
Ursodeoxycholic acid administered during very low-calorie dieting and weight loss after bariatric surgery is effective in preventing gallstone formation.
“Ursodeoxycholic acid administered during VLCD and weight loss after bariatric surgery is effective in preventing gallstone formation19–23”
From Gallstone Formation Prophylaxis After Gastric Restrictive Procedures for Weight Loss: A Randomized Double-Blind Placebo-Controlled Trial (2003) · cites this paper as [22]
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Metadata
- Authors
- Wudel, L. J., Wright, J. K., Debelak, J. P., Allos, T. M., Shyr, Y., & Chapman, W. C.
- Venue
- Journal of Surgical Research
- Publisher
- Elsevier BV
- Published
- 2002-01
- Volume
- 102
- Issue
- 1
- Pages
- 50-56
- ISSN
- 0022-4804
- Cited by
- 154
- References
- 0
- Language
- en
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