Gallbladder Ejection Fraction of 1%: Meaning and Management
A gallbladder ejection fraction (GBEF) of 1% represents severely impaired gallbladder contractility consistent with functional gallbladder disorder (gallbladder dyskinesia), and in patients with typical biliary symptoms, laparoscopic cholecystectomy is the recommended treatment. 1
What Does GBEF of 1% Mean?
A GBEF of 1% is profoundly abnormal, falling far below the normal threshold of ≥38% established by standardized cholecystokinin-cholescintigraphy (CCK-CS) protocols. 2, 1
This indicates severe gallbladder dysfunction where the gallbladder is essentially non-functional and unable to contract properly to expel bile. 1
The diagnosis is functional gallbladder disorder (also called gallbladder dyskinesia or chronic acalculous gallbladder disease), which represents a motility disorder affecting the gallbladder in the absence of gallstones. 3
Diagnostic Verification Before Treatment
Before proceeding with management, ensure the following:
Verify standardized testing protocol: Confirm the HIDA scan used 0.02 μg/kg sincalide infused over 60 minutes (not rapid infusion), as rapid infusion can cause false results and non-specific symptoms. 1, 4
Confirm proper patient preparation: Patient should have been fasting and avoided medications that affect gallbladder contraction. 1
Rule out structural biliary pathology: Perform ultrasound to exclude gallstones, sludge, or gallbladder wall thickening. 1
Evaluate liver function tests: If abnormal (particularly elevated GGT), consider evaluation for common bile duct stones. 1
Management Algorithm
For Patients with Typical Biliary Symptoms:
Laparoscopic cholecystectomy is recommended for GBEF of 1% when patients present with characteristic biliary colic symptoms. 1
Studies show 84-90% of patients experience complete symptom relief following cholecystectomy for abnormal GBEF, with another 13% experiencing partial relief. 5, 3
Chronic cholecystitis is found in approximately 60% of surgical specimens on final pathology, even in the absence of gallstones. 6
Before Surgery, Exclude Alternative Diagnoses:
Sphincter of Oddi dysfunction: Consider this particularly if symptoms began after cholecystectomy or if pain persists despite gallbladder removal. 2, 1
Functional gastrointestinal disorders: Including irritable bowel syndrome and functional dyspepsia. 2
Gastroesophageal reflux disease and peptic ulcer disease: Common mimics of biliary pain. 2, 1
Pancreatic disorders: Especially if amylase/lipase are elevated. 2
Important Clinical Caveats
Symptom provocation during CCK infusion is NOT a reliable diagnostic indicator and should not be used to guide surgical decision-making. 2, 7
GBEF cutoff values below 35-40% are consistently associated with gallbladder dysfunction, and your patient's value of 1% is unequivocally abnormal. 5, 3
Non-surgical management in patients with abnormal GBEF results in persistent symptoms in approximately 59% of cases at follow-up. 5
Expected Outcomes
Approximately 81% of patients achieve long-term symptom relief following cholecystectomy for functional gallbladder disorder. 7
If symptoms persist after cholecystectomy (occurs in ~19% of cases), re-evaluate for sphincter of Oddi dysfunction, functional GI disorders, or other alternative diagnoses. 1, 7