CoChat
Sign Up
Cited by 23Bariatric Surgery and OutcomesGallbladder and Bile Duct DisordersBiliary and Gastrointestinal Fistulas

The DOI matches its Crossref record; 58 of the 58 references it cites were found in a registry or an index; 9 of the 51 sources its claims cite were checked for support.

Prevention of Gallstones After Bariatric Surgery using Ursodeoxycholic Acid: A Narrative Review of Literatures

Open access
Son, Sang-Yong, Song, Jeong Ho, Shin, Ho-Jung, Hur, Hoon, Han, Sang-Uk·2022·Journal of Metabolic and Bariatric Surgery
DOI 10.17476/jmbs.2022.11.2.30PMC PMC10011673
Open this paper in CoChat — free accountOpen PDF

Abstract

Obesity by itself is a factor in the development of gallstone disease, and periods of weight loss after bariatric surgery further increase the risk of gallstone formation. In patients with obesity, hypersecretion of cholesterol may increase the risk of gallstone formation, which is approximately five-fold higher than that in the general population. The incidence of gallstone formation after bariatric surgery is 10-38% and often associated with a proportional increase in the risk of developing biliary complications. Routine postoperative administration of ursodeoxycholic acid (UDCA) is recommended to prevent gallstone formation. Several randomized trials have indicated that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric procedures. The effective daily dose of UDCA in each study ranged from 500 to 1,200 mg, and it may be considered at least during the period of rapid weight loss (first 3-6 months postoperatively) to decrease the incidence of symptomatic gallstones.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review evaluates whether ursodeoxycholic acid (UDCA) prevents gallstones after bariatric surgery. It concludes that prophylactic UDCA, at least 500 mg daily during the first 6 months postoperatively, reduces gallstone formation, though optimal dose and duration remain uncertain.

Key findings

  • Gallstone incidence after bariatric surgery is reported as 10–38%, with some studies up to 40%; obesity itself carries approximately a five-fold higher risk than the general population.
  • UDCA effectively prevents gallstones and reduces cholecystectomy risk after bariatric procedures; effective daily doses ranged from 500 to 1,200 mg, and most randomized trials used 500–600 mg daily for 6–12 months.
  • In the reviewed RCTs, UDCA groups had lower gallstone incidence than controls, e.g., Nabil et al. 2019: 6% vs. 40%; Talha et al. 2020: 6.5% vs. 22%; Haal et al. 2021 symptomatic gallstones: 6.5% vs. 9.7%.
  • A meta-analysis of eight cohort studies (94,855 sleeve gastrectomy [SG] and 106,844 Roux-en-Y gastric bypass [RYGB]) found SG had a 35% lower gallstone rate (OR 0.65; 95% CI 0.49–0.86) and lower cholecystectomy incidence (OR 0.54; 95% CI 0.30–0.99) than RYGB.

Methods

  • Narrative review of literature on gallstone prevention after bariatric surgery using UDCA.
  • Summarizes recent incidence data from 2020–2022 (Table 1), studies on UDCA for gallstone resolution (Table 2), and 11 randomized controlled trials of UDCA after bariatric surgery (Table 3).
  • Main analysis is narrative synthesis of these studies, meta-analyses, and clinical practice guidelines; no systematic search strategy or quality assessment is stated in the paper.

Limitations

  • The paper states that most studies were from Western or Middle Eastern countries, so results should be interpreted cautiously in Asian countries; whether long-term UDCA (12–24 months) is more effective than 6–12 months is unclear; different dosages may be required by surgical procedure; and more robust studies are needed to determine optimal dosage and administration period.
  • Evident from the text: this is a narrative rather than systematic review, with heterogeneous doses, procedures, follow-up periods, and outcome definitions (symptomatic vs. asymptomatic gallstones) across included studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.17476/jmbs.2022.11.2.30

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

9 of 51 cited sources checked · 1 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    The association between weight loss and gallstone formation is particularly pronounced when the nadir is reached.

    “Interestingly, a retrospective study has demonstrated that this association between weight loss and gallstone formation was particularly pronounced when the nadir was reached [23].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] Aldriweesh, 2020, Front Surg source

      The Discussion (page unavailable) reports an association between greater weight loss and cholelithiasis after bariatric surgery, and says the highest weight-loss percentages occurred at follow-ups 1–2 years after surgery. It does not establish that the association was particularly pronounced when patients reached their weight nadir; the Results instead report a significant duration finding at follow-up beyond two years. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingcitation

    Only 11 randomized controlled trials have reported the effect of UDCA on gallstone formation after bariatric surgery.

    “However, only 11 randomized controlled trials have reported the effect of UDCA on gallstone formation after bariatric surgery (Table 3) [1225264849505152535455].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [12] Haal, 2021, Lancet Gastroenterol Hepatol source

      The Research in context section reports that a search through March 1, 2016 found six randomised controlled trials of UDCA after bariatric surgery, all with gallstone formation as the primary endpoint. It supports the existence of such trials, but not the claimed total of 11; the earlier search cutoff also means its count does not establish a contrary total for a later date. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [25] Sugerman, 1995, Am J Surg source
    • cites [26] Adams, 2016, Obes Surg source
  • Premisecitation

    The PEGASUS-D study reported that both 300 and 600 mg UDCA were effective in reducing the incidence of gallstones after gastrectomy for gastric cancer.

    “For instance, the PEGASUS-D study has reported that both 300 and 600 mg UDCA were effective in reducing the incidence of gallstones after gastrectomy for gastric cancer [57].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [57] Lee, 2020, JAMA Surg source
  • Premisecitation

    Younger patients have a higher risk of gallstone formation after bariatric surgery.

    “Age: Younger patients have a higher risk of gallstone formation after bariatric surgery [12,13].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [12] Haal, 2021, Lancet Gastroenterol Hepatol source

      The Introduction identifies obesity and rapid weight loss as risk factors for gallstone formation after bariatric surgery, but does not compare risk by patient age. Searches for younger patients and age-related risk found no passage in our copy supporting that comparison. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [13] Golzarand, 2022, Dig Dis Sci source
  • Premisecitation

    Obesity is a risk factor for the development of gallstone disease.

    “Obesity by itself is a factor in the development of gallstone disease”
    • Also stated in: § INCIDENCE OF GALLSTONES AFTER BARIATRIC SURGERY AND PREDISPOSING FACTORS · boosted
      “Obesity is an established risk factor for the development of gallstone disease”
    • Also stated in: § INCIDENCE OF GALLSTONES AFTER BARIATRIC SURGERY AND PREDISPOSING FACTORS · boosted
      “Obesity is a known risk factor for gallstone formation”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] Stender, 2013, Hepatology source

      The Discussion (page not available) concludes that elevated BMI per se is likely a causal risk factor for symptomatic gallstone disease, supporting the point that obesity itself may contribute to risk. The citing sentence states this without the paper’s uncertainty and does not distinguish symptomatic disease from gallstone disease generally. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [19] Coupaye, 2015, Surg Obes Relat Dis source
  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 3

  • It may state two separate claims as one.

    Premisecitation

    In a recent systematic review, the risk of de novo post-bariatric gallstones was 8.2%, not substantially higher than asymptomatic gallstone disease (20.7%).

    “In a recent systematic review, gallstone disease was classified as symptomatic or asymptomatic, and the risk of de novo post-bariatric gallstones was not substantially higher (8.2%) than that of asymptomatic gallstone disease (20.7%) [1617].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [16] Fearon, 2022, Surg Obes Relat Dis source
    • cites [17] Amorim-Cruz, 2023, J Gastrointest Surg source

      The Results section (‘Risk of Developing De Novo Gallstone Disease’) assigns 20.7% to de novo post-bariatric gallstone disease and 8.2% to de novo symptomatic disease. The citing sentence reverses those categories by calling 8.2% the risk of de novo gallstones and 20.7% the risk of asymptomatic disease; the paper does not make that comparison. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    More recent studies indicated that concomitant laparoscopic cholecystectomy with SG or RYGB did not affect mortality or risk of major complications, and was only associated with a 0.6% increased risk of surgical site infection.

    “More recent studies have indicated that concomitant laparoscopic cholecystectomy with SG or RYGB did not affect mortality or the risk of major complications, and it was only associated with a 0.6% increased risk of surgical site infection, although the practice of routine concomitant cholecystectomy has steadily decreased over the past decades [3637].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [36] Worni, 2012, Obes Surg source

      The Results (page not provided) report higher in-hospital mortality and higher postoperative complication rates with concomitant cholecystectomy, contrary to the claimed absence of increased risk. The reported infection rates were 0.77% versus 0.42%, not a 0.6-percentage-point increase in surgical-site infection. The paper does support a decline in concomitant cholecystectomy, but it studies laparoscopic gastric bypass, not sleeve gastrectomy. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [37] Wood, 2019, Surg Obes Relat Dis source

  • It may state two separate claims as one.

    Premisecitation

    UDCA has demonstrated promising results with a minimum dose of 500 mg/day, and even higher doses did not yield greater benefits.

    “UDCA has demonstrated promising results with a minimum dose of 500 mg/day, and even higher doses did not yield greater benefits (Table 2) [3940414243].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [39] Tokyo Cooperative Gallstone Study Group, 1980, Gastroenterology source
    • cites [40] Tint, 1982, Ann Intern Med source
    • cites [41] Erlinger, 1984, Hepatology source

      The Treatment Groups and Duration section identifies 500 mg/day as a proposed UDCA dose, and the Abstract reports better dissolution at its corresponding mean dose of 8.4 mg/kg/day than at the higher dose of 16.2 mg/kg/day. But the conclusion says treatment was effective at doses as low as 2 mg/kg/day, so the paper does not support 500 mg/day as the minimum effective dose. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • Rests on an assumption: UDCA works by reducing the saturation of bile with cholesterol and increasing the solubility of cholesterol, which can prevent new gallstones and dissolve existing gallstones.

  • Probably not a substantial claim.

    Premisecitation

    The American Clinical Practice Guidelines recommend oral administration of UDCA 500-1,000 mg daily during the first 3-6 months postoperatively.

    “Therefore, based on the results of several clinical trials, the American Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient recommend oral administration of UDCA 500–1,000 mg daily during the first 3–6 months postoperatively [56].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [56] Mechanick, 2013, Obesity (Silver Spring) source

      In Methods, recommendation R68 says oral ursodeoxycholic acid at least 300 mg daily in divided doses may be considered after bariatric surgery for patients who have not had a cholecystectomy. Its supporting discussion reports trials using 300–1,200 mg daily. The guideline does not specify the claimed recommendation of 500–1,000 mg daily for the first 3–6 postoperative months. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • Rests on an assumption: UDCA works by reducing the saturation of bile with cholesterol and increasing the solubility of cholesterol, which can prevent new gallstones and dissolve existing gallstones.

  • It may state two separate claims as one.

    Findingreasoning

    Most studies used 500-600 mg of UDCA daily for 6-12 months postoperatively; consequently, the incidence of gallstone formation was lower in the UDCA group.

    “Most studies used 500–600 mg of UDCA daily for 6–12 months postoperatively; consequently, the incidence of gallstone formation was lower in the UDCA group.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    In a meta-analysis of eight cohort studies, the SG group had a 35% lower rate of gallstones (OR 0.65; 95% CI 0.49-0.86) and a significantly lower incidence of cholecystectomy (OR 0.54; 95% CI 0.30-0.99) than the RYGB group.

    “In a recent meta-analysis of eight cohort studies (94,855 SGs and 106,844 RYGBs), the SG group had a 35% lower rate of gallstones (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.49–0.86) and a significantly lower incidence of cholecystectomy (OR, 0.54; 95% CI, 0.30–0.99) than the RYGB group [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Wan, 2021, Surg Obes Relat Dis source

  • It may state two separate claims as one.

    Premisecitation

    A recent meta-analysis of randomized controlled trials reported that UDCA decreases bile lithogenicity, concluding that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric surgery.

    “A recent meta-analysis of these randomized controlled trials has reported that UDCA decreases bile lithogenicity, concluding that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric surgery [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Mulliri, 2022, J Gastroenterol source
    • Rests on an assumption: UDCA works by reducing the saturation of bile with cholesterol and increasing the solubility of cholesterol, which can prevent new gallstones and dissolve existing gallstones.

  • It may state two separate claims as one.

    Interpretationreasoning

    The exact mechanism by which gallstones form after bariatric surgery remains unclear; however, a combination of changes in bile composition and increased biliary tract pressure may be involved.

    “The exact mechanism by which gallstones form after bariatric surgery remains unclear; however, a combination of changes in bile composition and increased biliary tract pressure may be involved in gallstone formation.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Current clinical practice guidelines do not recommend ultrasound screening for asymptomatic gallstones yet recommend concomitant cholecystectomy only for symptomatic patients undergoing bariatric surgery.

    “Hence, the current clinical practice guidelines do not recommend ultrasound screening for asymptomatic gallstones yet recommend concomitant cholecystectomy only for symptomatic patients undergoing bariatric surgery [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Leyva-Alvizo, 2020, Surg Obes Relat Dis source

  • It may state two separate claims as one.

    Premisecitation

    Prophylactic cholecystectomy was historically recommended in the era of open surgery; however, many studies reported it is associated with longer operative time, higher complications, longer hospital stays, and increased mortality.

    “PC was historically recommended in the era of open surgery; however, many studies have reported that PC is associated not only with a longer operative time, but also with a higher rate of complications, longer hospital stays, and even increased mortality [333435].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [33] Chang, 2016, Surg Obes Relat Dis source
    • cites [34] Morais, 2016, World J Surg source
    • cites [35] Bonfrate, 2014, Best Pract Res Clin Gastroenterol source

  • It may state two separate claims as one.

    Premisecitation

    Increased saturation of bile with cholesterol can cause the formation of cholesterol monohydrate crystals, which can aggregate to form gallstones.

    “This increased saturation can cause the formation of cholesterol monohydrate crystals, which can then aggregate to form gallstones [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Portincasa, 2006, Lancet source

  • It may state two separate claims as one.

    Premisecitation

    In the Swedish Obese Subjects study, the incidence of gallstones after bariatric surgery increased over time, and the difference between surgery and control groups increased from 2.5% at 2 years to 5.2% at 20 years.

    “The incidence of gallstones after bariatric surgery increased over time in the Swedish Obese Subjects study, and the difference in the incidence of gallstones between the surgery and control groups also increased from 2.5% at 2 years postoperatively to 5.2% at 20 years postoperatively [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Anveden, 2020, Surg Obes Relat Dis source

  • Probably not a substantial claim.

    Interpretationreasoning

    Different dosages of UDCA may be required depending on the surgical procedure.

    “Lastly, different dosages of UDCA may be required depending on the surgical procedure.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    In the Swedish Obese Subjects study, the surgery group was associated with increased risk of symptomatic gallstone disease and increased risk for cholecystectomy (P<0.001 and P=0.002).

    “The surgery group was associated with increased risk of symptomatic gallstone disease and increased risk for cholecystectomy (P<0.001 and P=0.002, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Anveden, 2020, Surg Obes Relat Dis source

  • Probably not a substantial claim. It may state two separate claims as one.

    Interpretationnone given

    Most studies were from Western or Middle Eastern countries; therefore, the results should be interpreted or implemented cautiously in Asian countries.

    “First, most studies were from Western or Middle Eastern countries; therefore, the results should be interpreted or implemented cautiously in Asian countries.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    Extremely rapid (>1.5 kg/week) or excessive weight reduction (>25% of total body weight) may lead to a lithogenic state and initiate biliary sludge and gallstones.

    “However, the following two specific settings are exceptions: extremely rapid (>1.5 kg/week) or excessive weight reduction (>25% of the total body weight) [202122]. Both cases may occur after bariatric surgery or administration of weight loss medications, which may lead to a lithogenic state and subsequently initiate biliary sludge and gallstones [22].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Broomfield, 1988, N Engl J Med source
    • cites [21] Liddle, 1989, Arch Intern Med source
    • cites [22] Weinsier, 1995, Am J Med source

  • It may state two separate claims as one.

    Premisecitation

    The time of gallstone formation differs according to the type of procedure; approximately 30% of gallstones occur within 6 months after RYGB or biliopancreatic diversion, whereas a comparable incidence occurs at 6-12 months after SG.

    “previous studies have demonstrated that the time of gallstone formation differs according to the type of procedure; approximately 30% of gallstones were reported within 6 months after Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion, whereas a comparable incidence was reported at 6–12 months after sleeve gastrectomy (SG) [242526].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [24] Shiffman, 1993, Int J Obes Relat Metab Disord
    • cites [25] Sugerman, 1995, Am J Surg source
    • cites [26] Adams, 2016, Obes Surg source
17 of 17

  • The paper relies on this without support.

    UDCA works by reducing the saturation of bile with cholesterol and increasing the solubility of cholesterol, which can prevent new gallstones and dissolve existing gallstones.

    “UDCA works by decreasing the saturation of bile with cholesterol, which reduces the risk of cholesterol crystal formation and gallstone development.”
    “UDCA works by reducing the saturation of bile with cholesterol and by increasing the solubility of cholesterol, which can help to prevent the formation of new gallstones and dissolve existing gallstones.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • MGB share of the 580-patient cohort is misstated

    Minor

    The table lists 147 MGB patients out of 580, which is 25.3%, not 2.5%.

    Reported 2.5 · recomputed 25.344828

1 of 1

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Amorim-Cruz, 2023, J Gastrointest Surg
  2. Shiffman, 1993, Int J Obes Relat Metab Disord, 17, 153
  3. Worobetz, 1993, Am J Gastroenterol, 88, 1705

Cited by

Sorted by citations

Related

Metadata

Authors
Son, S.-Y., Song, J. H., Shin, H.-J., Hur, H., & Han, S.-U.
Affiliations
Ajou University (KR)
Corresponding author
Son, Sang-Yong
ORCID
Venue
Journal of Metabolic and Bariatric Surgery
Publisher
XMLink
Published
2022
Volume
11
Issue
2
Pages
30
ISSN
  • 2287-2930 (ISSN-L)
  • 2508-5956
DOI
10.17476/jmbs.2022.11.2.30
PMC
PMC10011673
OpenAlex
W4323763637
Cited by
23
References
58
Citations by year
2026: 5 · 2025: 13 · 2024: 4 · 2023: 1
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Metabolic and Bariatric Surgery (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Gastroenterology › Gallbladder and Bile Duct Disorders
  • Health Sciences › Medicine › Gastroenterology › Biliary and Gastrointestinal Fistulas
Keywords
gallstone prevention, ursodeoxycholic acid, bariatric surgery, obesity, weight loss, biliary complications, cholecystectomy, postoperative prophylaxis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-11-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review