Udca Dosage, Duration, and Initiation Timing for Post-metabolic Bariatric Surgery Scholelithiasis Prevention: A Scoping Review

Metabolic Bariatric Surgery (MBS), an effective intervention for severe obesity, elevates the risk of cholelithiasis (CL) due to rapid weight loss and altered biliary metabolism. Ursodeoxycholic acid (UDCA) is increasingly investigated as a prophylactic strategy to mitigate this complication. This scoping review aimed to map and compare UDCA dosage, duration, and initiation timing protocols for CL prevention after MBS. A review was conducted across PubMed/MEDLINE, Web of Science, and Scopus, selecting 10 articles published between 2014 and 2023. The analyzed literature consistently indicates that UDCA prophylaxis significantly reduced CL incidence from 25 to 40% in control groups to 1.4–10.8% in treated groups. Studies commonly reported dosages of 500–600 mg/day for 6 months postoperatively were common, with early initiation being crucial. Efficacy is evident for both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB), with CL relative risks between 0.13 and 0.36. The evidence demonstrates UDCA safety, efficacy, and cost-effectiveness. Collectively, the literature supports UDCA as an effective and safe prophylactic measure against post-MBS cholelithiasis. The identified heterogeneity in protocols underscores the need for standardization to optimize clinical application. The literature consistently indicates UDCA significantly reduces cholelithiasis risk after Metabolic Bariatric Surgery. Commonly reported UDCA regimens in the literature are 500–600 mg/day for 6 months postoperatively. Evidence highlights that early initiation of UDCA prophylaxis is critical for optimal outcomes. Studies demonstrate UDCA use to be safe, effective, and cost-effective.