The Chronic Acalculous Symptomatic Hyperkinetic (CASPER) Gallbladder or "The Excitable Gallbladder"

Area of Science:

• Gastroenterology
• Hepatobiliary Medicine
• Symptomatic Gallbladder Disorders

Background:

• Gallbladder hypokinesia is established, but gallbladder hyperkinesia is a recently appreciated condition.
• The Chronic Acalculous Symptomatic hyPERkinetic (CASPER) gallbladder is contrasted with the hyPOkinetic (CASPO) gallbladder.
• Gallbladder hyperkinesia is increasingly recognized in the 21st century.

Purpose of the Study:

• To provide an updated review of gallbladder hyperkinesia for medical and lay audiences.
• To consolidate clinical information gathered over the past five years.
• To discuss diagnostic criteria, differential diagnoses, and management considerations.

Main Methods:

• Review of clinical information and literature on gallbladder hyperkinesia.
• Analysis of diagnostic features including biliary symptoms, absence of gallstones, and elevated gallbladder ejection fraction on HIDA scan.
• Development of a 12-point checklist for CASPER gallbladder symptoms and signs.

Main Results:

• Gallbladder hyperkinesia is defined by biliary symptoms, acalculous nature, and elevated gallbladder ejection fraction.
• A 12-point checklist for CASPER gallbladders is presented, with deviations from Rome IV Criteria noted.
• Challenges in conducting randomized controlled trials for cholecystectomy indication are highlighted.

Conclusions:

• Gallbladder hyperkinesia is a diagnosis of exclusion requiring careful investigation.
• Further statistical studies are needed to confirm diagnostic cut-off levels for gallbladder ejection fraction.
• Social media platforms play a role in connecting patients and recognizing clinicians for this condition.