From the Guidelines
A gallbladder ejection fraction of 7% is significantly below normal, indicating gallbladder dysfunction, and according to the most recent and highest quality study, a normal gallbladder ejection fraction is defined as ≥38% 1. This condition should be evaluated by a gastroenterologist or general surgeon to determine the best course of action. Some key points to consider in the evaluation and management of this condition include:
- The patient's symptoms, such as right upper quadrant pain, nausea, or digestive issues after meals, which may indicate the need for further intervention, such as cholecystectomy (surgical removal of the gallbladder) 1.
- The use of medications like ursodeoxycholic acid to improve bile flow or smooth muscle relaxants like nifedipine to help with gallbladder contraction, which may be prescribed before surgery 1.
- Dietary modifications, including low-fat meals, smaller portions eaten more frequently, and avoiding trigger foods, which may help manage symptoms. The low ejection fraction indicates that the gallbladder isn't contracting properly to release bile when stimulated, which can lead to bile stasis, inflammation, and potentially stone formation, causing digestive problems since bile is essential for fat digestion. Follow-up imaging and consultation with specialists are important next steps to determine the most appropriate treatment plan, taking into account the patient's individual needs and the latest clinical guidelines 1.
From the Research
Gall Bladder Ejection Fraction of 7%
A gallbladder ejection fraction of 7% is considered abnormal, as the normal range is typically between 35% and 80% [ 2 ].
Diagnosis and Treatment
- Abnormal gallbladder emptying is typically indicated by a GBEF below 35% on cholescintigraphy following cholecystokinin administration [ 2 ].
- Patients with a low GBEF may experience symptoms such as recurrent, intense, and enduring pain, often exacerbated by fatty food consumption, localized in the upper right quadrant or epigastric region [ 2 ].
- Laparoscopic cholecystectomy may be considered as a management approach for patients with abnormal gallbladder emptying and symptoms suggestive of biliary obstruction [ 2 ].
- The use of cholecystokinin stimulation during cholescintigraphy to calculate the gallbladder ejection fraction has been associated with variable clinical results as a preoperative indicator for chronic acalculous cholecystitis and postoperative relief of biliary symptoms [ 3 ].
Related Conditions
- Biliary dyskinesia (BD) is a disorder characterized by abdominal pain of biliary origin, absence of gallstones on ultrasound, and a decreased gallbladder ejection fraction on a cholecystokinin-cholescintigraphy hepatobiliary iminodiacetic acid (CCK-HIDA) scan [ 2 ].
- Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear [ 4 ].
Management
- Cholecystectomy may be considered for patients with a gallbladder ejection fraction between 35% and 60% if the patient's symptoms are classical for biliary disease and have been present for 1 year [ 3 ].
- ERCP with endoscopic sphincterotomy (ES) within 24 to 48 hours is also suggested for the treatment of acute gallstone pancreatitis [ 5 ].