{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T18:18:34Z","timestamp":1774549114633,"version":"3.50.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This review aims to evaluate the cumulative incidence proportion, incidence rate, and risk factors for progression of incidentally diagnosed, asymptomatic gallstones to symptomatic gallstone disease (GSD) and associated complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic Review and Meta-Analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Data source<\/jats:title>\n                    <jats:p>Four electronic databases were searched (PubMed, Scopus, Web of Science, and ScienceDirect) with no start date restriction, up to July 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Inclusion criteria: patients who were diagnosed with gallstones incidentally. Exclusion criteria: known history of GSD, patients who have undergone bariatric surgery or cholecystectomy, recurrence of gallstones, pregnancy, estrogen therapy, pediatric age group, review, case report, case series, editorial, letters, and abstracts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>This review is registered with PROSPERO (CRD42024526889). Primary screening by title and abstract was conducted in Rayyan; full-text screening was performed, and the references of the included studies were manually searched for relevant papers. Data were extracted into an Excel sheet, and the meta-analysis was conducted using RStudio. Single-arm outcomes were summarized in proportion, and comparative outcomes were summarized in Risk Ratio (RR) for categorical outcomes and mean difference for continuous ones. Heterogeneity was evaluated using the I statistic and the Q test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight cohort studies, reported in 9, with a total of 25,924 participants, were included. The cumulative incidence proportion of symptomatic progression was 0.10, 95% CI: [[0.10; 0.11]] at 5 years, 0.19, 95% CI: [0.14; 0.25] at 10 years, and 0.26, 95% CI: [0.12; 0.40] at 15 years. Alcohol consumption (RR: 1.32, 95% CI: [1.27; 1.38]) and hyperlipidemia (RR: 1.19, 95% CI: [1.07; 1.32]) were identified as risk factors. Chronic liver disease (RR: 0.76, 95% CI: 0.67; 0.87) and male gender (RR: 0.54, 95% CI: 0.33; 0.87) were observed as protective factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec007\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review examines factors influencing symptomatic progression of ASG and guides the identification of high-risk patients who may benefit from prophylactic measures such as cholecystectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345462","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T17:29:46Z","timestamp":1774546186000},"page":"e0345462","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Asymptomatic gallstones: Cumulative incidence proportion, incidence rate, and risk factors for symptoms development: Systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Mohammad","family":"Alzoubi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Omar Saleh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah Al","family":"Omari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8402-4983","authenticated-orcid":true,"given":"Kinda","family":"Shatnawi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Batool","family":"Hyari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ala\u2019a","family":"Qashou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Daradka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salam","family":"Daradkeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Abu Hilal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Parente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"4","key":"pone.0345462.ref001","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1440-1746.2009.06146.x","article-title":"Natural history of gallstone disease: Expectant management or active treatment? 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