A case of low gallbladder ejection fraction

A common scenario that comes up in the GI forum that I moderate is the subject of acalculous biliary pain (ABP – gallbladder pain in the absence of gallstones). The NY Times has an interesting case of this today, where it was diagnosed by repeating the HIDA scan with CCK stimulation. It is a common recommendation that those with a low gallbladder ejection fraction benefit from a cholecystectomy:

In people with normal gallbladders, the ejection fraction ranges between 35-75 percent. Patients who suffer from bouts of biliary pain and have lower ejection fraction readings are assumed to have ABP. Studies have shown that surgical removal of the gallbladder (cholecystectomy) helps ABP patients more than 90 percent of the time.

However, there is some controversy surrounding this recommendation, as seen from this meta-analysis:

These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence-based.

Bottom-line: although cholecystectomy may have helped this particular case in the NY Times, prospective studies are needed before making this a definitive recommendation.

topics: gallbaldder, cholecystectomy

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  • Mary

    If a normal ejection fraction is between 35% and 75%, what does an ejection fraction greater than 75% indicate?


  • Anonymous

    mayor a 75% también es normal.

  • Beth

    i have a low ejection fraction of 28% and i have no idea what this means, if any symptoms i have are bc of this, if it leads to other things ect.. ect.. ect.., can n e one help me? please write to me at my email addy with any info. thank you beautyboo2003@yahoo.com. thank you so much

  • Anonymous

    hi, i have a ejection fraction of 32% my symptons are strong abdomminal pain, and i cannot keep any food down do i need my gallbladder removed? Anyone else with these symptoms?

    worried teenager

  • Anonymous

    i have a ejection fraction 0f 86% is this normal?kim

  • Jeff

    wow, I guess I am glad I am getting a surgical eval tomorrow because my ejection fraction is 4%. I will post the results of the eval tomorrow. Still debating surgery. I don’t have nausea and I can eat normally (I already have a very low fat diet). I do have constant dull sore pain. This is my second episode and has lasted since start of August. Looking forward to evaluating options.

  • Jeff

    I will have surgery tomorrow. The surgeon basically said it is not working. Granted, I have had -ultrasound, -liver enzyme test, -Hep A,B,C test, -pancreatitis test, and HIDA with 4%EF but -bile duct stones. So the due diligence is done and I agree…yank it out doc!

  • Robin

    I have a low ejection rate of 26% the Dr recomends removal of the gallbladder. I have pain under right ribbs, that gets wouse as the day goes on. All this started from a high dose of Prednisone, does anyone know if this could be the cause or a coinsedence.

  • Anonymous

    My ejection fraction is 13%. I have acute upper right rib pain, that sometimes hurts terriblly when I hit a bump in the road or my 4 lb. Maltese tries to step over my right side of my abdomen. Surgical eval with be with my favorite surgeon tomorrow.

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