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Biliary Dyskinesia with Reduced Gallbladder Ejection Fraction: A Diagnostic and Therapeutic Shift in Management

Menna-Allah Elaskandrany1, Mohamed Ismail2, Yiyan Liu3

  • 1Department of Internal Medicine Lenox Hill Hospital.

Journal of Brown Hospital Medicine
|March 3, 2025
PubMed

Insights

Reduced gallbladder ejection fraction (GBEF) without gallstones may indicate biliary issues. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy resolved symptoms, suggesting their value before gallbladder removal.

Area of Science:

  • Gastroenterology
  • Hepatobiliary Medicine

Background:

  • Reduced gallbladder ejection fraction (GBEF) with normal laboratory tests and no gallstones on ultrasound can indicate various biliary conditions.
  • Differential diagnoses include biliary dyskinesia, chronic acalculous cholecystitis, cystic duct syndrome, and sphincter of Oddi dysfunction.

Observation:

  • A patient presented with chronic right upper quadrant pain, diagnosed with reduced GBEF, normal labs, and no gallstones.
  • Symptoms persisted despite initial evaluations, highlighting a diagnostic challenge.

Findings:

  • Endoscopic retrograde cholangiopancreatography (ERCP) revealed a mild, non-obstructive stricture in the middle third of the common bile duct.
  • Sphincterotomy during ERCP led to complete resolution of the patient's symptoms.

Implications:

  • This case suggests ERCP and sphincterotomy are valuable diagnostic and therapeutic tools for reduced GBEF with normal initial workups.
  • Considering these endoscopic interventions may prevent unnecessary cholecystectomies in select patients.
  • Highlights the importance of investigating subclinical biliary strictures in functional gallbladder disorders.

Keywords:
Biliary dyskinesiaFunctional gastrointestinal disordersMilwaukee classificationRome IVSphincter of Oddi

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