American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for adult patients with asymptomatic gallstones?

1. Immediate cholecystectomy

2. Observation

3. Medication therapy

4. Endoscopic retrograde cholangiopancreatography (ERCP)

The correct answer is: Observation

In the case of adult patients with asymptomatic gallstones, the recommended approach is observation. Asymptomatic gallstones are often discovered incidentally during imaging studies performed for other reasons. Most individuals with gallstones that do not cause symptoms will remain symptom-free throughout their lives. The rationale for this observation approach lies in the fact that the majority of gallstones do not lead to complications or symptoms, making immediate interventions like surgery unnecessary. The decision to recommend observation instead of surgery hinges on the understanding that while some patients may go on to develop symptoms or complications, the overall risk of this happening is relatively low in asymptomatic cases. Surgical intervention, such as cholecystectomy, is typically reserved for symptomatic patients or those at risk for complications, like pancreatitis or cholangitis. Monitoring patients instead of pursuing immediate treatment minimizes unnecessary risks associated with surgery, such as postoperative complications, especially since many patients are older or may have comorbidities that increase surgical risks. Therefore, the option of observation is the chosen management strategy for adult patients presenting with asymptomatic gallstones, reflecting a conservative approach in the face of a common and benign condition.