The use of cholecystokinin stimulation during cholescintigraphy to calculate the gallbladder ejection fraction has been associated with variable clinical results as a preoperative indicator for chronic acalculous cholecystitis and postoperative relief of biliary symptoms. A series of 56 consecutive patients was analyzed to determine the accuracy of a decreased gallbladder ejection fraction as a preoperative indicator for acalculous cholecystitis. Each patient had symptoms compatible with biliary disease. Each patient had a decreased gallbladder ejection fraction calculated by cholescintigraphy. The gallbladder ejection fraction was calculated using a 30-minute intravenous infusion of cholecystokinin at a dose of 0.02 microg/kg during cholescintigraphy. There was a 100% correlation found in this series of patients between a decreased gallbladder ejection fraction during cholescintigraphy, preoperative symptoms of gallbladder disease, and postoperative pathology evidence of acute or chronic cholecystitis. Only 1 patient had less than a complete resolution of her preoperative symptomatology after laparoscopic removal of her gallbladder. This patient had irritable bowel disease, which was diagnosed postoperatively. Six symptomatic patients with a gallbladder ejection fraction between 35% and 60% were also treated by laparoscopic removal of the gallbladder with complete resolution of their preoperative symptomatology. The use of a 30-minute infusion of cholecystokinin at a dose of 0.02 microg/kg to calculate the gallbladder ejection fraction during cholescintigraphy is an accurate test to preoperatively predict acalculous cholecystitis and postoperative relief of biliary symptoms. The gallbladder ejection fraction of less than 35% was abnormal. Cholecystectomy may be considered for patients whose gallbladder ejection fractions were calculated to be between 35% and 60% if the patient's symptoms were classical for biliary disease and have been present for 1 year. The use of a 30-minute intravenous infusion of cholecystokinin at a dose of 0.02 microg/kg to calculate the gallbladder ejection fraction during cholescintigraphy is an accurate test to preoperatively predict acalculous cholecystitis and postoperative relief of biliary symptoms.