Gallstone disease: on whom we should operate and on whom we do operate-an Italian snapshot

Gallstone disease affects one-fifth of the population in Western countries, with 20% of patients experiencing biliary colic. The remaining 80% of patients are asymptomatic or report abdominal symptoms other than biliary colic (mild-symptomatic). International guidelines recommend cholecystectomy for symptomatic patients and surveillance for non-symptomatic individuals, without specific recommendations for mild-symptomatic. The laparoscopic approach has increased cholecystectomy rates, potentially extending indications to mild and asymptomatic cases. This study presents the results of a survey among physicians involved in the management of gallstone disease, focusing on the adherence of their clinical approach to 2016 EASL guidelines. The survey involved 220 physicians (surgeons, gastroenterologists, radiologists, and general practitioners). Participants completed a questionnaire addressing their professional characteristics, including the volume of gallstone patients treated yearly. Based on their knowledge and experience, physicians expressed their therapeutic approach for ten clinical scenarios, encompassing asymptomatic, mild-symptomatic and symptomatic patients. 89% of participants recommended cholecystectomy for patients suffering from biliary colic, while 48.1% recommended surgery for asymptomatic or mild-symptomatic patients. Remarkably, 20% of gastroenterologists and general practitioners suggested litholytic therapy for asymptomatic and mild-symptomatic cases. Factors favoring surgery included: patients under 40, mild symptoms and less than 10 years of clinical experience for surgeons. Disparities persist in the clinical management of gallstone disease patients, deviating from guidelines. Despite inconclusive evidence supporting the benefit of cholecystectomy for mild and asymptomatic cases, our study shows that a significant proportion of physicians indicate cholecystectomy as the preferred treatment, indicating a significant gap between practice and guidelines.