Sasmal PK, Singh PK, Sahoo A, Dutta T. Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine. World J Gastrointest Surg 2025; 17(11): 110501 [DOI: 10.4240/wjgs.v17.i11.110501]
Corresponding Author of This Article
Prakash K Sasmal, MS, FNB (Minimal Access Surgery), FACS, Professor, Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneshwar 751019, Odisha, India. surg_prakash@aiimsbhubaneswar.edu.in
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Surgery
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sasmal PK, Singh PK, Sahoo A, Dutta T. Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine. World J Gastrointest Surg 2025; 17(11): 110501 [DOI: 10.4240/wjgs.v17.i11.110501]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 110501 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.110501
Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine
Prakash K Sasmal, Pradeep K Singh, Ankit Sahoo, Tanmay Dutta
Prakash K Sasmal, Pradeep K Singh, Department of General Surgery, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Ankit Sahoo, Department of Surgical Gastroenterology, SGPGIMS, Lucknow 226014, Uttar Pradesh, India
Tanmay Dutta, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Author contributions: Sasmal PK designed the review; Singh PK, Sahoo A, and Dutta T performed the literature search; Sasmal PK, Singh PK, Sahoo A, and Dutta T wrote and reviewed the paper. All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prakash K Sasmal, MS, FNB (Minimal Access Surgery), FACS, Professor, Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneshwar 751019, Odisha, India. surg_prakash@aiimsbhubaneswar.edu.in
Received: June 10, 2025 Revised: June 23, 2025 Accepted: October 11, 2025 Published online: November 27, 2025 Processing time: 170 Days and 21.5 Hours
Abstract
Incidental asymptomatic gallstone disease (AGD) is prevalent, but its management remains contentious. Old-fashioned conservative care is under scrutiny today with precision medicine and artificial intelligence (AI) on the horizon. Unlike previous overviews, this review primarily focuses on clinical outcomes, surgical decision-making, and the integration of genomics, predictive analytics, and precision tools into AGD management. We emphasise how AI-based models and precision diagnostics enable tailored recommendations, preventing unnecessary cholecystectomy in low-risk patients while requiring early elective surgery in high-risk subgroups (e.g., single large stones, polyps, endemic cancer areas). We also compare cost-effectiveness, surgical safety, and quality of life (QoL) measures within this precision strategy. Our vision is to overcome the binary "operate or observe" model by leveraging technology-enabled forecasting and collaborative decision-making to deliver future-proof care for AGD. The terminology of asymptomatic gallstones was used more meticulously in the era of open cholecystectomy, when neither the diagnostic tools nor the concept of minimal access surgery were available. After careful consideration of the evidence on natural history, risk of surgery, QoL, and cost, we recommend that clinicians utilise shared decision-making and present information regarding cholecystectomy as an intervention option to all patients with asymptomatic gallstones.
Core Tip: Asymptomatic gallstones are incidentally detected on imaging. Aside from an extremely small number of patients who eventually have issues, in a few cases, life-threatening, most never become symptomatically apparent. Our treatment strategy for such patients has evolved over the years, driven by advances in imaging, laparoscopy, artificial intelligence (AI), and precision medicine. Physicians can now weigh the risk and decide who could benefit from early intervention with more advanced diagnostic and predictive tools. This review highlights how precision tools, including genomics, AI, and decision-support systems, will cause a paradigm shift in management from a one-size-fits-all approach to an individualised, patient-centred approach.
