To Assess the Ejection Fraction of Gallbladder in Patients of Cholelithiasis in a Tertiary Care Centre: A Case–control Study

Abstract

Background: The gallbladder (GB) stores and concentrates bile and ejects it under the influence of cholecystokinin; disordered motility contributes to gallstone pathogenesis. GB ejection fraction (GBEF), measured after physiologic stimulation, serves as a key indicator of GB function. Ultrasound-based estimation provides a safe, accessible, and radiation-free alternative to scintigraphy. Objective: The aim of the study was to assess and compare the GBEF in patients with cholelithiasis and in age- and sex-matched healthy controls in a tertiary care setting. Materials and Methods: This case–control study was conducted in the Department of General Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Haryana. Seventy-two adults with sonographically confirmed cholelithiasis and 72 matched controls were included over 18 months after ethical approval and informed consent. Patients with acute cholecystitis, mucocele, pyocele, acalculous cholecystitis, carcinoma GB, or outside the 18–65-year age range were excluded. After overnight fasting, baseline GB volume was measured ultrasonographically and recalculated 60 min after a standard fatty meal (half-and-half milk). Volumes were determined using the ellipsoid formula (V = L × W × H × 0.5), and GBEF was computed as ([Preprandial–Postprandial]/Pre-prandial) × 100. Statistical analysis was performed using Statistical Package for the Social Sciences version 21.0; P < 0.05 was considered significant. Results: The case and control groups were comparable for age (P = 0.328) and sex (P = 0.655). Laboratory parameters, including hemoglobin, liver enzymes, and bilirubin, showed no significant differences (all P > 0.05). Mean preprandial GB volume was significantly higher in cases (22.79 ± 12.43 cc) than in controls (15.38 ± 4.94 cc) (P = 0.0001), as was postprandial volume (13.26 ± 11.76 vs. 10.19 ± 4.38 cc; P = 0.040). GB wall thickness was also greater in cases (3.42 ± 1.84 mm) compared to controls (2.78 ± 0.75 mm; P = 0.007). GBEF was markedly reduced in cholelithiasis patients (33.42 ± 6.26%) versus controls (52.56 ± 9.78%) (P = 0.0001), indicating significant contractile dysfunction. Common bile duct diameter did not differ significantly (P = 0.895). Conclusion: Patients with cholelithiasis demonstrated significantly impaired GB contractility, increased wall thickness, and higher fasting and residual volumes compared to healthy individuals. These findings indicate that GB dysmotility may both contribute to and result from gallstone formation. Ultrasound-based assessment of GBEF using a fatty meal stimulus is a reliable, non-invasive tool for evaluating GB function and may aid early diagnosis, prognosis, and management in cholelithiasis.