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Sonographic Assessment of Volumetric Gallbladder Contraction

Variability in Relation to Dietary Lipid Proportions

Bains K, Gupta S, Chea P, Perez-Martell J, Castillo A, Akunuri M, Gill N, Bien-Aime F, Joliat C, Ho S,
Zinzuwadia S, Hundal J, Vanadurongvan T, Wynn A, Wynn D

Ross University School of Medicine, Roseau, Commonwealth of Dominica, West Indies

Ultrasonography is a preferred method in assessing gallbladder contractility and has been used to determine variance in
individuals gallbladder contractility after administration of a standardized fatty meal. However, it is not known if there is any
difference in contractility after administering an individualized fatty meal according to American Heart Association
recommendations based on body mass index. Fourteen healthy volunteers were asked to fast overnight for fifteen hours
before ingesting one-third of their recommended daily saturated fat intake in accordance with AHA. Fasting gallbladder
volume was then measured using ultrasound and then recorded every fifteen minutes for two hours. The cohort exhibited
fasting gallbladder volumes ranging 4.85 24.67 mL and a residual volume of 2.8 6.72 mL with percent maximum
contraction of 40.36 81.25%. Time of maximum contraction was shown to be 67.5 minutes on average with a 95%
confidence interval between 47.7 87.23 minutes (p = 0.0285). Data showed variance still existed in gallbladder contraction
after ingesting an individualized fatty meal and it also showed that maximum contraction occurs around 67.5 minutes rather
than at previously reported 45 minutes. Further studies should be done to confirm these findings.

INTRODUCTION Figure 1: Postprandial sonographic images of the gall bladder

There are numerous imaging practices available to visualize and qualify the level of gallbladder contraction; however, RESULTS
ultrasonography is a preferred technique given the lack of radiation exposure to subject, along with ease of data replication Gallbladder volume measurements had a wide range in the given cohort. In the subjects, the fasting gallbladder volume ranged
without adverse risks[1]. This quick and simple technique can be utilized in assessing gallbladder contractility in general or from 4.85 24.67 mL and the residual gallbladder volume ranged 2.8 6.72 mL, with a mean volume and standard deviations
after administration of cholecystokinetic agents, such as a high fat content substance [2]. It has been previously shown that of 14.29 6.38 and 4.73 1.62, respectively. The calculated percentage of maximum contraction ranged from 20.36 81.25%
sonographic assessment of gallbladder contraction after ingesting a fatty meal is a useful tool to examine cystic duct with a mean and standard deviation of 64.33% 13.14%. Data suggests that the average time to maximum contraction was
patency [1,2]. Using fourteen healthy individuals, this study sought to assess variation in gallbladder contraction after 67.5 minutes (figure 2). A two tailed t-test presented with a 95% confidence interval between 47.7 87.23 minutes (p = 0.0285).
personalized daily dietary saturated fat intake with respect to American Heart Association (AHA), rather than administration Utilizing a repeated measures ANOVA, further examination of data showed no statistically significant correlation of maximum
of a fixed amount for each subject. The goal of this study is to simply assess variation in contractility and in no means seeks contraction between genders (p = 0.6847), activity levels of sedentary versus active (p = 0.9082) and BMI of normal versus
to be a diagnostic tool for any biliary or cystic duct pathologies and conditions. obese/overweight (p = 0.2928).
Fourteen participants (7 males and 7 females) from Ross University in Picard, Dominica, with no prior medical history of
In conclusion, this data shows that even with an individualized saturated fat intake the degree of gallbladder contraction varies
hepatobiliary diseases, lactose intolerance, and diabetes mellitus volunteered for this study. Their ages ranged from 23 to
among individuals; however, compared to a standardized saturated fatty intake that has shown to have a maximum contraction
30 years. Participants were asked about their past medical history, to exclude above mentioned health conditions, and
around 45 minutes, a more realistic and individualized intake has shown to have a maximum contraction at around 67.5
average physical activity. Subjects were informed about the nature of the study and its implication a few days prior to the Figure 2: Distribution of time to maximum
minutes. Further work needs to be performed to replicate and confirm these findings.
study. Ethics committee approval for the protocol was obtained from the Institutional Review Board at Ross University gallbladder contractility of 14 subjects
School of Medicine. Ultrasonography examinations of the gallbladder were performed by a single observer using a Sonosite
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M Turbo Ultrasound with the participant in supine position and quantified using the ellipsoid formula (volume = 0.52[width x volume. AJR 1985;145:1009-1011.
height x length]). Participants were asked to observe an overnight 15 hour fast with the exception of water. Weight and 2. Donald JJ, Fache JS, Buckley AR, Burhene HJ. Gallbladder contractility: variation in normal subjects. AJR 1991;157:753-
corresponding body mass index (BMI) was calculated (weight in kilograms/ [height in meters]2) and recorded for each 3. Chukwuka UA, Kalu AK, Felix EO. Variabilities of gallbladder contraction indices and a simple regression model for
individual. After recording fasting gallbladder volume, participants ingested one third of their daily saturated fat intake in the gallbladder and gastric emptying ratio. Pan African Med Journal 2011;9:11
4. Chukwuka UA, Kalu AK. Ultrasound quantification of gallbladder volume to establish baseline contraction indices in
form of powdered generic milk, as determined by the American Heart Association (cite). Postprandial residual volume healthy adults: a pilot study. The South African Radiographer 2010;48:9-12.
measurements were recorded every 15 minutes for two hours. Percent of gallbladder contractions was calculated using: 5. Glasbrenner B, Pieramico O, Holzwarth C, Malfertheiner P. Simultaneous sonographic study of postprandial gastric
emptying and gallbladder contraction. Bildgebung 1992;59:88-93.
(fasting gallbladder vol-residual gallbladder vol)/(fasting gallbladder vol)100. Averages and standard deviation of fasting 6. Mutirangura P, Siwawetkul W. Gallbladder contraction capacity in response to liquid fatty meal: a real time
volume, residual volume, and percent of gallbladder contraction were calculated, along with the variance in contractility ultrasonographic study. J Med Assoc Thai1996;79:640-647.
among participants. All statistical tests were performed at the 5% significance level and conducted in STATA 12.0 ACKNOWLEDGEMENTS
(StataCorp, College Station, TX). This study was possible thanks to the Wynns ultrasound equipment, RUSM CTL for accommodations, and RUSM volunteers