Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine

Table 1 Elective cholecystectomy vs expectant management in asymptomatic gallstone disease

Parameter	Prophylactic surgery	Expectant management
Risk of complications	Low when elective; increases in elderly/comorbid patients	Low initially; increases with time in high-risk patients
Clinical risk	Large solitary stone; ≥ 10 mm polyp/rapid growth, calcified non-functioning gall bladder, haemolysis, immunosuppression	Small stones without high-risk features; low comorbidity; reliable access to urgent care
Quality of life impact	Can be improved in symptomatic or high-risk patients	Stable; may decrease if complications
Risk of gallbladder cancer	Lower in selected high-risk groups (e.g., solitary large stones)	Higher in endemic areas with large stones or familial risk
Cost-effectiveness	More cost-effective in high-risk, elderly patients	More cost-saving in young, low-risk patients with very good follow-up
Postoperative complications	Bile duct injury, diarrhoea, dyspepsia (1%-5%), possible	None at first, but the danger of emergency surgery complications

Table 2 Benefits of emerging technologies, artificial intelligence in asymptomatic gallstone disease management

Technology	Application	Benefits
Risk models using AI	Predict transition from asymptomatic to symptomatic disease	Reduces unnecessary surgery, focuses on early intervention
Genomic markers	Detect genetic predisposition to gallstones	Facilitates early diagnosis and tailored management
Mobile health apps	Track symptoms and allow remote monitoring	Enhances patient activation and self-triage
Wearables	Detect motility changes and early inflammation	Allows proactive, non-invasive surveillance
CDSS with EHR	Automated risk scoring and clinical decision support	Facilitates evidence-based, equitable delivery of care

AI: Artificial intelligence; CDSS: Clinical decision support systems; EHR: Electronic health record.