Gallbladder Ejection Fraction of 92%: Hypercontractile Classification
A gallbladder ejection fraction of 92% falls within the normal range (upper limit approaches 100%), but emerging evidence suggests that values ≥81% may represent "biliary hyperkinesia" and could be clinically significant in patients with typical biliary symptoms. 1, 2
Understanding the Normal Range and Hyperkinesia Threshold
The American Gastroenterological Association defines normal GBEF as ≥38%, with the upper limit approaching 100%, and historically stated there was no convincing evidence that high normal values were clinically significant. 1, 3, 4
However, a 2023 study from the Journal of the American College of Surgeons analyzing 1,596 patients identified an EF cutoff of 81% as a reasonable upper limit of normal, with patients having EF ≥81% showing significantly better symptom resolution after cholecystectomy (78.2% vs 60.0% for EF <81%, p=0.03). 2
Your GBEF of 92% exceeds this 81% threshold and would be classified as biliary hyperkinesia according to this recent evidence. 2
Clinical Significance and Management Algorithm
Step 1: Verify proper testing methodology
- Confirm the HIDA scan used standardized protocol: 0.02 μg/kg sincalide infused over 60 minutes (not rapid infusion <30 minutes, which causes non-specific symptoms). 1, 3, 4
Step 2: Characterize your symptoms
- Biliary hyperkinesia is only clinically relevant if you have typical biliary colic: episodic right upper quadrant pain, often postprandial, lasting 30 minutes to several hours. 5, 2
- If symptoms are atypical or non-specific, other diagnoses are more likely. 4
Step 3: Rule out alternative pathology
- Ensure ultrasound excluded gallstones, sludge, or gallbladder wall thickening. 1, 3
- Exclude other common causes: sphincter of Oddi dysfunction, GERD, peptic ulcer disease, functional dyspepsia. 1, 3, 4
Step 4: Consider cholecystectomy if appropriate
- For patients with biliary colic and EF ≥81% (including your 92%), cholecystectomy is recommended based on the 2023 Mayo Clinic study showing 78.2% symptom resolution. 2
- Multiple case reports confirm excellent outcomes with cholecystectomy for hyperkinetic gallbladders (EF 86-97%), with complete symptom resolution. 5
- Pathology typically shows chronic cholecystitis in 61.7% of these cases despite normal imaging. 2
Important Caveats
The concept of biliary hyperkinesia remains somewhat controversial, as traditional guidelines from the American Gastroenterological Association did not recognize high GBEF as pathologic. 1, 4
The 2023 study represents the most robust evidence to date (analyzing 141 cholecystectomy patients), but it is still relatively recent and not yet incorporated into major society guidelines. 2
Symptom provocation during CCK infusion is not a reliable diagnostic indicator and should not influence decision-making. 4
Before proceeding with surgery, a thorough workup to exclude alternative diagnoses is essential, as cholecystectomy is irreversible. 1, 3, 4