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

Reduced gallbladder ejection fraction (GBEF) with normal laboratory tests and no gallstones on ultrasound can be attributed to conditions such as biliary dyskinesia, chronic acalculous cholecystitis, cystic duct syndrome, sphincter of Oddi dysfunction, and subclinical biliary stricture. We present a case of a patient with chronic right upper quadrant pain, diagnosed with reduced GBEF, normal labs, and no gallstones. The patient's symptoms resolved after endoscopic retrograde cholangiopancreatography and sphincterotomy, revealing a mild, non-obstructive stricture in the middle third of the common bile duct. This case underscores the importance of considering ERCP and sphincterotomy as diagnostic and therapeutic options before opting for cholecystectomy in patients with reduced GBEF and normal lab results, potentially avoiding unnecessary surgical interventions.