Management Of Gallbladder Disease Research Articles

Day-case laparoscopic cholecystectomy in the management of gallbladder disease: a literature review.

Day-case laparoscopic cholecystectomy (DCLC) has gained traction globally due to its benefits, including shorter hospital stays, reduced costs, and enhanced patient experience. While concerns about patient safety, particularly related to bleeding and bile duct injury persist, the literature supports the efficacy and advantages of DCLC highlighting the need for its wider adoption in healthcare settings to optimise resources and improve patient outcomes. This was a literature review that aims to assess the feasibility and safety of day-case laparoscopic cholecystectomy for symptomatic gallstone patients, focusing on incidence and aetiology of unexpected admissions and readmissions, as well as conversion-to-open rates. PubMed was searched for all studies focusing on DCLC between 2014 and 2024. The timeframe was specifically selected to identify recent trends and practices in this evolving field. By focusing on this specific period, the review aims to provide a comprehensive analysis of current practices, emerging trends, and the evolving standard of care in this area. This review highlights that the main causes of unexpected admission post DCLC were postoperative nausea, vomiting, and pain, while the implementation of anaesthetic pathways notably increased day-case rates. Studies addressing complication rates postoperatively consistently found no significant difference between day-case and in-patient procedures. DCLC for symptomatic gallstone patients is supported by research as safe and effective, with high success rates and patient satisfaction. Studies show minimal complications and acceptable readmission rates, suggesting that DCLC can be the standard approach for selective patients, improving outcomes and healthcare efficiency.

Transumbilical laparoscopy for pneumoperitoneum establishment: a comprehensive multicentre evaluation affirming safety, feasibility, and a range of clinical benefits.

Transumbilical laparoscopy (TUL) has emerged as a promising technique for establishing pneumoperitoneum in laparoscopic cholecystectomy, offering potential safety, feasibility, and clinical benefits. This retrospective multicentre study aims to evaluate the efficacy and outcomes of TUL in the management of gallbladder diseases. A retrospective analysis was conducted on a cohort of 2,543 patients who underwent TUL between 2011 and 2021 across various medical institutions in Italy. Data collection included demographic, clinical, intraoperative, and postoperative parameters. Standardized protocols were followed for preoperative and postoperative management. The TUL technique involved precise anatomical incision and trocar placement. The study demonstrated favorable outcomes associated with TUL, including a low conversion rate to open surgery (0.55%), minimal intraoperative complications (0.16%), and short hospital stays (average 2.4 days). The incidence of incisional hernias was notably low (0.4%). Comparison with existing literature revealed consistent findings and provided unique insights into the advantages of TUL. Despite limitations, such as the absence of a control group and the retrospective nature of the study, the findings contribute valuable insights to the literature. They inform surgical decision-making and advance patient care in laparoscopic cholecystectomy for gallbladder diseases. Transumbilical laparoscopy shows promise as a safe and feasible technique for establishing pneumoperitoneum in laparoscopic cholecystectomy. The study's findings support its clinical benefits, including low conversion rates, minimal complications, and short hospital stays. Further research, including prospective studies with control groups, is warranted to validate these results and optimize patient outcomes.

Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives.

In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited.

The Effect of a Microlearning Module on Knowledge Acquisition in Surgery Clerkship Students

Microlearning has been found to be beneficial in other areas of healthcare education. The purpose of this study was to investigate the effect of a microlearning module compared to a traditional online learning module in undergraduate medical education. A microlearning module was developed to cover the etiology and management of gallbladder disease. Surgery clerkship students were randomized into 2 groups. One group began with the microlearning module (MLM). The second group began with a 45 minute commercially available module centered on gallbladder disease (WISE-MD™). Halfway through the clerkship, the groups crossed over to the other learning intervention. Student knowledge was assessed with a test at three time points (pre-test, post-test1, post-test2). Third year surgery clerkship students at George Washington University. There were 56 students in the MLM and 57 in WISE-MDTM groups. In the MLM group, mean scores significantly increased from pre-test to post-test1 and pre-test to post-test2, but significantly decreased from post-test1 to post-test2. In the WISE-MD™ group, mean scores significantly increased from pre-test to post-test1 and pre-test to post-test2, with no significant change from post-test1 to post-test2. After the initial intervention, test scores of post-test1 of the MLM group were significantly higher than the WISE-MD™ group, while there were no significant differences between groups at the pre-test or post-test2 time points. Students exposed to the microlearning module first performed significantly better on a post intervention test than students that used a commercially available product in our standard curriculum. Therefore, the use of microlearning modules may lead to improved knowledge acquisition in surgery clerkship students.

Choledocholithiasis-a new clinical pathway.

The incidence of cholecystectomy in children has increased considerably since the early 1990s. Management of gallbladder disease in children must include an awareness of choledocholithiasis treatment strategies. Both endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct exploration (open or laparoscopic) are accepted management techniques for choledocholithiasis. Laparoscopic cholecystectomy with preoperative or postoperative ERCP is at least a two-procedure process while cholecystectomy with laparoscopic common bile duct exploration (LCBDE) can provide definitive treatment in a single procedure under one anesthetic. Despite this, the trend over the last decade continues towards less LCBDE utilization in favor of ERCP. This trend has resulted in decreased familiarity with LCBDE by adult and pediatric surgeons and their trainees. Access to the necessary tools and education on the technical aspects can allow for successful single-stage treatment of choledocholithiasis by surgeons during laparoscopic cholecystectomy. This may include a pre-defined stepwise algorithm and understanding of all the equipment and resources necessary to perform a LCBDE. Ultimately, increased understanding of the equipment and procedural steps necessary for LCBDE will result in widened adoption of the technique and thus confer advantages to the patient such as decreased length of stay and fewer required anesthetics.

Efficacy of laparoscopy for acute Cholecystitis: A comparative study

Background: Laparoscopic cholecystectomy (LC) represents a significant change in the management of gallbladder disease and it is the most commonly performed operation of the digestive tract. It is considered as the gold standard treatment for Cholelithiasis. For acute Cholecystitis, however, the use of laparoscopic cholecystectomy has been controversial up until recently, because of the high open conversion rate and the high incidence of postoperative complications.Aim of the study: To study efficacy of laparoscopy for acute Cholecystitis.Materials and methods: For the study, we retrospectively reviewed the medical records of patients aged 30-65 years with acute Cholecystitis who underwent Laparoscopic cholecystectomy (LC) and were compared patients who underwent open cholecystectomy (OC). A total of 120 patients (70 for LC and 50 for OC) were reviewed.Results: Our study group comprised of 120 total patients. 70 had undergone LC and 50 had undergone OC. On comparing the demographics of the patients, the results were found to be statistically non-significant for all the parameters. We observed that mean operative time for LC was 49.69 min and for OC was 62.36 min.Conclusion: Within the limitations of the present study, it can be concluded that laparoscopic cholecystectomy has equal efficacy for acute Cholecystitis patients as compared to open cholecystectomy.

Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery.

The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.

Gallbladder Hypoplasia Treated by Laparoscopy: A Case Report and Literature Review

The gallbladder hypoplasia is a rare congenital anomaly. We present a case of a 38-year-old man who was referred to us for surgical management of gallbladder disease. The patient presented abdominal pain compatible with repeating biliary colic as the first clinical manifestation. Preoperatively, the magnetic resonance cholangiopancreatography imaging was useful to study thoroughly the biliary tract in order to avoid any iatrogenic injury. Intraoperatively, laparoscopy revealed a rudimentary gallbladder and the histopathological examination confirmed the diagnosis of hypoplasic gallbladder. Laparoscopic cholecystectomy was successful and the patient did not present abdominal pain again.

Role of Ultrasound in the Diagnosis and Management of Gall Bladder Diseases

Background & objective: The majority of published data on the sensitivity and specificity of ultrasound (US) in the diagnosis of gallbladder pathology was conducted over 30 years ago. Since then the quality and resolution of ultrasonography has improved significantly. It is, therefore, essential to asses afresh whether the progression in technology has translated into improved diagnostic accuracy. The present study was undertaken to find the usefulness of US in diagnosing gallbladder diseases with particular reference to cholecystitis and gall bladder carcinoma.
 Methods: This cross-sectional observational study was conducted at the Department of Radiology and Imaging, Rajshahi Medical College, Rajshahi in collaboration with the Departments of General Surgery and Histopathology of the same Medical College between July 2016 to June 2018. A total of 128 patients were initially included on the basis of signs and symptoms of gallbladder diseases. All these patients were subjected to abdominal US to achieve a ultrasonic diagnosis of gall bladder disease followed by histopathological examination of biopsy material taken from the gall bladder or specimen of the operated gall bladder. The accuracy of ultrasound in the diagnosis of gall bladder diseases was determined by comparing the ultrasound sound diagnosis with that of histopathological diagnosis. In particular, the role of ultrasound was evaluated in the differentiation of benign gall bladder diseases from those of malignant ones.
 Result: Age distribution of the patients shows that over one-third (35.9%) was ≥50 years old followed by 24.9% 40-50 years, 21.9% 30 - 40 years and 16.4% 20 – 30 years old with mean age of the patients being 43.8(range: 18-80) years. Females outnumbered males by roughly 11:9. In terms of BMI, 6.2% were underweight, 16.4% overweight, and 4.7% obese. The predominant complaints reported by the patients were pain in the right upper abdomen (95.3%), epigastric pain (94.7%), abdominal discomfort (96.9%) followed by nausea (75%), low-grade fever (37.5%), jaundice (26.6%) and vomiting (26.6%). Approximately 44% of the patients exhibited anaemia. Nearly half (46.1%) of the patients exhibited sonographic Murphy’s sign. Hyperechoic echo character was invariably obtained with 12.5% cases having hypoechoeic character as well. Over 90% of the patients had gall-stones, 62.5% cholecystitis (thickened gall-bladder wall). Ultrasound comment on the type of diseases revealed that 112(87.5%) were benign diseases and 16(12.5%) malignant cases. Approximately 55% of the gall bladder diseases diagnosed by histopathology were cholecystitis. Histopathological comment shows that about 90% of the diseases were benign and the rest (10.2%) were malignant. The sensitivity of ultrasound in diagnosing cholecystitis was 85.9%, while the specificity of the test was 60.9% with overall diagnostic accuracy of the test being 73.4%. The US had a optimum sensitivity (84.6%) and high specificity (95.6%) in diagnosing gall-bladder carcinoma.
 Conclusion: The study concluded that US could be considered as the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis. It is also a useful imaging modality for diagnosing gall-bladder malignancy. Thus, US can be dependably used in the primary evaluation of heptobilliary pathology.
 Ibrahim Card Med J 2017; 7 (1&2): 70-75

Acute gallbladder disease

A century ago, William Mayo M.D. declared that there was no such thing as an innocent gallstone. We now understand that this is not true and that most gallstones are asymptomatic. Gallbladder disease is very common worldwide and this article aims to outline the incidence, aetiology, presentation and management of gallbladder disease. Complications can be life-threatening and require urgent referral. Adjustments to lifestyle may help prevent the development of gallbladder disease.

Management of gallbladder disease after sleeve gastrectomy in a selected Lebanese population

BackgroundPatients with morbid obesity are at a higher risk of developing gallstones after bariatric surgery. Studies on the incidence of symptomatic gallstones necessitating cholecystectomy after laparoscopic sleeve gastrectomy (LSG) are limited in the Middle East. ObjectivesThis study aims to assess the incidence of cholecystectomy after LSG during a 1-year follow-up and to evaluate potential risk factors and potential prophylactic measures. SettingTwo university hospitals in Lebanon. MethodsA prospectively maintained bariatric database of 361 patients who underwent primary LSG between January 2009 and December 2012 at the American University of Beirut Medical Center and Makassed General Hospital was reviewed. Data included demographics, preoperative weight, weight at 6 and 12 months postoperatively, and incidence of postoperative symptomatic cholelithiasis. ResultsA total of 319 patients (88.4%) were followed up at 1 year. Twenty-four (7.5%) had symptomatic gallstones and underwent cholecystectomy after LSG. Mean postoperative time for the development of symptomatic gallstones was 426 days (range, 91–1234 days). Patients who developed symptomatic gallstones were significantly younger (29.8 versus 34.8, P = 0.008) but comparable to patients who did not undergo cholecystectomy in terms of other baseline characteristics and weight loss results at 1 year. Out of the obesity-related co-morbidities, hypertension was the only co-morbidity associated with post-LSG cholecystectomy (OR = 3.35, P = 0.036) after multivariate adjustment. ConclusionThe incidence of symptomatic gallstones requiring cholecystectomy after LSG in our study cohort was higher than that of the general population (7.5%). This incidence does not warrant prophylactic cholecystectomy or routine pre- or postoperative ultrasounds.

Spontaneous Cholecystocutaneous Fistula

ABSTRACT Spontaneous biliary fistulae are encountered, not very rarely, in one's surgical practice. These fistulae are of three types: Internal, external, and combined. Internal spontaneous biliary fistulae are the commonest. External fistulae could be spontaneous or because of therapeutic, iatrogenic, or traumatic reasons are extremely rare. Spontaneous cholecystocutaneous fistula (SCCF), secondary to calculous cholecystitis, is an extremely rare presentation in the present-day scenario. It used to be quite common before the year 1900, but is very rare now because of better management of cholecystitis and cholelithiasis. Usually, SCCF is a complication of neglected chronic cholelithiasis. This is seldom seen today because of the early diagnosis and better management made feasible by ultrasound as first-line investigation, broad spectrum antibiotics, and effective surgical management of biliary tract diseases. It is a very rare case of 35-year-old female patient presenting in the outpatient department, with the multiple stones carefully preserved, which she had been extruding through the fistulous opening in the umbilicus, for the last 1 year. She was investigated and was operated for the same condition. Though the entity is very rare, clinicians should keep this condition in mind while examining any case of chronic discharging sinus or fistula on the abdominal wall, particularly the wound extruding stones in which case the diagnosis is selfrevealing. In the absence of positive history of expelling stones, the diagnosis can be confirmed by computerized tomogram fistulography. Though the early diagnosis and improvement in the management of gallbladder disease has improved tremendously, the possibility of this condition arising mostly from the neglected gallbladder disease should always be kept in mind as such cases are again being reported from all over the world. How to cite this article Abbey R. Spontaneous Cholecystocutaneous Fistula. Int J Adv Integ Med Sci 2016; 1(4):196-198.

Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria

Background: Diseases of the gallbladder (GB) do affect its size and wall thickness. GB diseases are common pathology frequently encountered in medical practice and presents as right upper quadrant pain. Ultrasound is a relatively safe, inexpensive, and reproducible imaging modality for assessing normal or diseased GB. It is the first method of choice when GB disease is suspected. Objective: The aim of this study is to determine a referential value of normal GB size and thickness which can be used as baseline in this environment to determine GB disease and for follow-up of these patients. Materials and Methods: This is a cross-sectional study conducted on 400 normal adults aged 15–70 years at the radiology department over a period of 10 months. Subjects had their GB scanned with 3.5 MHz transducer after fasting overnight. The length, width, and height were measured and the volume obtained using the ellipsoid formula. GB thickness was also recorded. Results: The overall mean age was 40.70 ± 14.97. Mean age of males and females were 46.32 ± 15.64, and 36.61 ± 12.33 respectively. The mean values for length, width, height, volume, and wall thickness of the GB was 6.40 ± 1.06 cm, 2.38 ± 0.77 cm, 2.77 ± 0.25 cm, 23.46 ± 8.14 cm3 and 0.27 ± 0.08 cm respectively. The mean values for, length, width, height, volume, and wall thickness of GB for males were 6.36 ± 1.03 cm, 2.46 ± 0.87 cm, 2.81 ± 0.29 cm, 24 ± 8.66 cm3 and 0.28 ± 0.76 cm and for females were 6.44 ± 1.10 cm, 2.30 ± 0.67 cm, 2.75 ± 0.22, 22.98 ± 7.63 cm3, and 0.26 ± 0.27 cm. Mean GBV was higher in males than females. Conclusion: Normal values of GB dimensions have been established in the north central Abuja using ultrasound. These values can be used as reference values in management of GB disease.

Prevalence, clinical investigation, and management of gallbladder disease in Rett syndrome

This study determined the prevalence of cholelithiasis and/or cholecystectomy in Rett syndrome, described gallbladder function in a clinical cohort, and identified recommendations for assessment and management of gallbladder disease. The incidence of cholelithiasis/cholecystectomy was estimated from data describing 270 and 681 individuals with a pathogenic MECP2 mutation in the Australian Rett Syndrome Database and the International Rett Syndrome Phenotype Database respectively. Gallbladder function in 25 females (mean age 16y 5mo, SD 20y 7mo, range 3y 5mo-47y 10mo) with Rett syndrome (RTT) was evaluated with clinical assessment and ultrasound of the gallbladder. The Delphi technique was used to develop assessment and treatment recommendations. The incidence rate for cholelithiasis and/or cholecystectomy was 2.3 (95% confidence interval [CI] 1.1-4.2) and 1.8 (95% CI 1.0-3.0) per 1000 person-years in the Australian and International Databases respectively. The mean contractility index of the gallbladder for the clinical sample was 46.5% (SD 38.3%), smaller than for healthy individuals but similar to children with Down syndrome, despite no clinical symptoms. After excluding gastroesophageal reflux, gallbladder disease should be considered as a cause of abdominal pain in RTT and cholecystectomy recommended if symptomatic. Gallbladder disease is relatively common in RTT and should be considered in the differential diagnosis of abdominal pain in RTT.

Minireview on laparoscopic hepatobiliary and pancreatic surgery

The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious.

Su1361 Endoscopic Gallbladder Stent Placement in the Management of Gallbladder Disease in High-Risk Surgical Patients Without Cirrhosis

The use of endoscopic transpapillary gallbladder stents has been described as an alternative to cholecystectomy or cholecystostomy in patients with end stage liver disease. Limited data have been published on the use of gallbladder stents in a non-cirrhotic population. We describe our experience with transpapillary gallbladder stents in non-cirrhotic patients who are poor surgical candidates.

A Point-Specific Site for Placement of Epigastric Port in Iaparoscopic Management of Gallbladder Disease: An Observational Study

Backgound: Laparoscopic cholecystectomy has revolutionized the world in the surgical management of benign gallbladder disease. However, for any procedure to learn properly, anatomy becomes a major concern. Aims and Objectives: We present a point, a convenient site, speedily accessible by our maneuver of placing epigastric port on the patient. Materials and Methods: This is an outcome of an observation with the prospective study of 100 patients irrespective of age, sex, body habitus and severity of gallstone disease. Our point for epigastric port satisfies all the criteria for an ideal port. Results: Our general observation with majority of patients with this point specific epigastric port placement was that it is easy to locate, needs less thrust on trocar for creation, stays on the linea alba, is easily maneuverable facilitates safe, easy and speedy dissection, causes less portal bleeds and is easy to angulate towards the right of falciform ligament. Conclusion: The point specific epigastric port conveys many benefits to the operating surgeon in terms of easy location, adds safety and speed to the procedure, causes less portal bleeds, needs less thrust and is easy to angulate to the right of the falciform ligament adding technical ease to the surgeon. It is easy to be learnt, taught and practiced by the young surgeons.

腹部超音波検診にて発見された胆嚢疾患 (特に胆嚢結石・胆嚢ポリープ) の現況と管理方法について

腹部超音波検診にて発見された胆嚢疾患 (特に胆嚢結石・胆嚢ポリープ) の現況と管理方法について

Quantitative Assessment of Expression of Lactate Dehydrogenase and its Isoforms 3 and 4 may Serve as Useful Indicators of Progression of Gallbladder Cancer: A Pilot Study

We have studied the expression of lactate dehydrogenase and its isoforms in gall bladder cancer, cholelithiasis and chronic cholecystitis. Quantitative and qualitative assays of lactate dehydrogenase and its various isoforms were carried out in the blood sera of patients and healthy controls along with parallel estimation of various liver function test enzymes. Statistical analysis was done using the software Graph Pad Prism. Significantly high expression of lactate dehydrogenase along with alkaline phosphatase and total bilirubin (P≤0.05) was observed in all the three clinical conditions as compared to controls. LDH showed an increasing trend from stage I to stage IV of GBC indicating a significant positive association with the disease progression. The levels of LDH 3 and 4 isoforms appeared significantly more elevated in GBC than cholelithiasis or chronic cholecystitis. We suggest that a careful estimation of total LDH and its isoforms 3 and 4 alone or along with alkaline phosphatase and total bilirubin during different clinical stages, like chronic cholecystitis, cholelithiasis and GBC, may prove to be a potentially useful biomarker in the prognostic management of gall bladder diseases, specifically GBC.

A pilot algorithm for grading gallbladder diseases

The aim of this study is to grade the severity of gallbladder diseases using the Gallbladder Emptying Rate (GBER), which could indicate a rational treatment algorithm. The study design composed of five patients with gallbladder diseases, whose parameters were compared with a previous study of fifty healthy volunteers. Cholecystodynamic parameter (GBER) was derived by ultrasound assessment of gallbladder volumes during fasting and comparing it with post-prandial volumes obtained 20 min after an oral administration of 165 mls of cream milk. This model proposed 3 grades of gallbladder diseases among the patients studied. This proposed model could help in the grading of disease severity and management of gallbladder diseases. Key words: Milk ultrasonography, cholecystokinetic agent, gallbladder disease, algorithm.