Ejection fraction of normal gall bladder by ultrasonography in patients with biliary colic: Is it a parameter for cholecystectomy?.

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt

Abstract

Background: Functional biliary disorders such as gallbladder dyskinesia (GBD), biliary hyperkinesia, and sphincter of
Oddi dysfunction are common causes of abdominal pain. Although hepatobiliary scintigraphy is the gold standard for
diagnosing sphincter of Oddi dysfunction, there is still debate about the best way to establish diagnoses of GBD and
whether gallbladder ejection fraction (GBEF) is a reliable predictor of treatment outcomes.
Aim: The purpose of this study is to evaluate GBEF as a predictor of GBD and an indicator of cholecystectomy.
Patients and Methods: This is a prospective study conducted between July 2021 and December 2023 on patients presented
with biliary dyskinesia. All patients with an ejection fraction of less than 35% underwent laparoscopic cholecystectomy.
The preoperative workup involved clinical assessment, laboratory tests, fasting and postprandial ultrasounds, and
hepatobiliary scintigraphy to determine ejection fraction. Postoperative follow-up at 1, 3, and 6 months assessed pain
relief, symptom improvement, and patient satisfaction.
Results: Eight patients were excluded due to a GBEF greater than 35%. The remaining 21 patients with an ejection
fraction of less than 35% underwent laparoscopic cholecystectomy. The mean age was 31±12 years, and the majority
of patients (86%) were females. The preoperative visual analog scale pain score was 7.2±1.4, decreasing significantly
to 1.2±0.8 at 1-month follow-up (P<0.001). The pain was fully resolved in all patients by 3 months. Medication usage,
daily activity levels, and patient satisfaction also significantly improved. The mean ejection fraction was 27.1±3.3%. No
postoperative complications occurred.
Conclusion: In patients with GBD, laparoscopic cholecystectomy provided excellent symptomatic relief when GBEF
was less than 35%. The ejection fraction appears to be a useful diagnostic predictor of positive surgical outcomes in such
functional biliary pain presentations. Larger, controlled clinical trials are needed to generalize the findings.

Keywords

The Egyptian Journal of Surgery
Volume 43, Issue 4
October 2024
Pages 1597-1602

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