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
ABSTRACT
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
There are numerous imaging practices available to visualize and qualify the level of gallbladder contraction; however,
ultrasonography is a preferred technique given the lack of radiation exposure to subject, along with ease of data replication
without adverse risks[1]. This quick and simple technique can be utilized in assessing gallbladder contractility in general or
after administration of cholecystokinetic agents, such as a high fat content substance [2]. It has been previously shown that
sonographic assessment of gallbladder contraction after ingesting a fatty meal is a useful tool to examine cystic duct
patency [1,2]. Using fourteen healthy individuals, this study sought to assess variation in gallbladder contraction after
personalized daily dietary saturated fat intake with respect to American Heart Association (AHA), rather than administration
of a fixed amount for each subject. The goal of this study is to simply assess variation in contractility and in no means seeks
to be a diagnostic tool for any biliary or cystic duct pathologies and conditions.
METHODS
Fourteen participants (7 males and 7 females) from Ross University in Picard, Dominica, with no prior medical history of
hepatobiliary diseases, lactose intolerance, and diabetes mellitus volunteered for this study. Their ages ranged from 23 to
30 years. Participants were asked about their past medical history, to exclude above mentioned health conditions, and
average physical activity. Subjects were informed about the nature of the study and its implication a few days prior to the
study. Ethics committee approval for the protocol was obtained from the Institutional Review Board at Ross University
School of Medicine. Ultrasonography examinations of the gallbladder were performed by a single observer using a Sonosite
M Turbo Ultrasound with the participant in supine position and quantified using the ellipsoid formula (volume = 0.52[width x
height x length]). Participants were asked to observe an overnight 15 hour fast with the exception of water. Weight and
corresponding body mass index (BMI) was calculated (weight in kilograms/ [height in meters]2) and recorded for each
individual. After recording fasting gallbladder volume, participants ingested one third of their daily saturated fat intake in the
form of powdered generic milk, as determined by the American Heart Association (cite). Postprandial residual volume
measurements were recorded every 15 minutes for two hours. Percent of gallbladder contractions was calculated using:
(fasting gallbladder vol-residual gallbladder vol)/(fasting gallbladder vol)100. Averages and standard deviation of fasting
volume, residual volume, and percent of gallbladder contraction were calculated, along with the variance in contractility
among participants. All statistical tests were performed at the 5% significance level and conducted in STATA 12.0
(StataCorp, College Station, TX).
Figure 1: Postprandial sonographic images of the gall bladder
RESULTS
Gallbladder volume measurements had a wide range in the given cohort. In the subjects, the fasting gallbladder volume ranged
from 4.85 24.67 mL and the residual gallbladder volume ranged 2.8 6.72 mL, with a mean volume and standard deviations
of 14.29 6.38 and 4.73 1.62, respectively. The calculated percentage of maximum contraction ranged from 20.36 81.25%
with a mean and standard deviation of 64.33% 13.14%. Data suggests that the average time to maximum contraction was
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).
Utilizing a repeated measures ANOVA, further examination of data showed no statistically significant correlation of maximum
contraction between genders (p = 0.6847), activity levels of sedentary versus active (p = 0.9082) and BMI of normal versus
obese/overweight (p = 0.2928).
CONCLUSION
In conclusion, this data shows that even with an individualized saturated fat intake the degree of gallbladder contraction varies
among individuals; however, compared to a standardized saturated fatty intake that has shown to have a maximum contraction
around 45 minutes, a more realistic and individualized intake has shown to have a maximum contraction at around 67.5
Figure 2: Distribution of time to maximum
minutes. Further work needs to be performed to replicate and confirm these findings.
gallbladder contractility of 14 subjects
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ACKNOWLEDGEMENTS
This study was possible thanks to the Wynns ultrasound equipment, RUSM CTL for accommodations, and RUSM volunteers