Recommended Citation
Igbo AC, Stevenson J, Ezeano C, Alsabbagh M, Suresh A, Browne J. Ursodeoxycholic Acid Prophylaxis After Sleeve Gastrectomy and 1-Year Risk of Biliary Complications. Poster presentation at: Digestive Disease Week (DDW; May 2026; Chicago, IL.
Presentation Notes
Poster presentation at: Digestive Disease Week (DDW; May 2026; Chicago, IL.
Abstract
Introduction: Real-world effectiveness data for ursodeoxycholic acid (UDCA), commonly prescribed after sleeve gastrectomy to reduce the risk of biliary events, are limited. We evaluated whether UDCA within 6 months of sleeve gastrectomy reduces 1-year biliary complications across a multi-institution network. Methods: We performed a retrospective cohort study on TriNetX (Global Collaborative Network; 17 health care organizations). Adults (18–89 years) undergoing sleeve gastrectomy (CPT 43775) from 9/21/2015 onward were included. Exposure was UDCA (RxNorm 62427) within 6 months post-surgery vs no UDCA in the same window. The index date was the surgery date; outcomes were assessed for 365 days. Primary outcomes were cholelithiasis (K80), cholecystitis (K81), choledocholithiasis (K80.3/.4/.5), and cholecystectomy (comprehensive SNOMED/CPT/PCS set). Patients with prior outcomes were excluded. One-to-one propensity score matching balanced demographics (age/sex, race/ethnicity), with post-match N=4,704 per group. We estimated risk ratios (RR) and hazard ratios (HR) with Kaplan–Meier/log-rank tests. Results: Before matching, cohorts were UDCA n=4,830 and no-UDCA n=20,235; after matching, n=4,704 each with comparable covariates and ~365-day median follow-up. Cholelithiasis: UDCA 1.9% vs no-UDCA 2.8%; RR 0.68 (95% confidence interval [CI], 0.52–0.90), p=0.006; HR 0.67 (0.51–0.88); log-rank p=0.004. Cholecystitis: UDCA 0.6% vs 1.3%; RR 0.49 (0.32–0.77), p=0.001; HR 0.48 (0.31–0.75); log-rank p=0.001. Cholecystectomy: UDCA 1.3% vs 4.0%; RR 0.32 (0.24–0.42), p< 0.001; HR 0.31 (0.23–0.41); log-rank p< 0.001. Choledocholithiasis: UDCA 0.4% vs 0.6%; RR 0.65 (0.35–1.19), p=0.16; HR 0.64 (0.35–1.18); log-rank p=0.15 (not significant). Conclusions: In a large, real-world, propensity-matched cohort, UDCA within 6 months after sleeve gastrectomy was associated with significantly lower 1-year risks of cholelithiasis, cholecystitis, and cholecystectomy, with no significant difference for choledocholithiasis. There were no incidences of cholangitis, mortality, obstruction of the bile duct, or endoscopic retrograde cholangiopancreatography (CPT 43264, 43265, 43274). To our knowledge, this is one of the largest multicenter real-world cohorts evaluating UDCA prophylaxis specifically after sleeve gastrectomy, using propensity score matching and time-to-event analyses. These data support routine UDCA prophylaxis following sleeve gastrectomy to reduce downstream biliary events and surgeries. Strengths & Limitations: Multicenter network with rigorous propensity score matching and time-to-event analysis. Limitations include retrospective design, potential residual confounding (e.g., obesity severity, rapid weight-loss kinetics), medication adherence/dose unobserved, and coding dependencies. Future work should evaluate dose–response, adherence, and longer-term outcomes.
Type
Poster