Endoscopic Treatment for Bouveret Syndrome

Jin-cheng Zhao, MD, Ermilo Barrera, MD, Reza Salabat, MD, Woody Denham, MD, Dennis Leung, MS, Michael Ujiki, MD. NorthShore University HealthSystem, Chicago, IL.

Introduction: Gallstone ileus is an uncommon cause for small bowel obstruction. Less than 3% of cases are due to a gallstone impacted in the duodenum or pylorus resulting in a gastric outlet obstruction, described by Bouveret in 1896. Most of the successful therapeutic maneuvers described involve open surgical removal of the stone through either a gastrotomy or duodenotomy, and reported morbidity is not insignificant.

Methods: Video of successful endoscopic retrieval of a gallstone lodged in the pylorus are presented. An endoscopic retrieval basket is used and key maneuvers highlighted including, passage of the closed device distal to the stone, opening of the basket and withdrawl of the stone under direct vision.

Results: After successful retrieval, endoscopic inspection revealed a normal duodenum and relief of the obstruction. Cholecystectomy was not performed given that most cholecystoduodenal fistulae are large and will spontaneously close, especially if a patent cystic duct is present.

Conclusion: Endoscopic treatment is a less invasive option for treatment of Bouveret syndrome.

Session: VidTV2
Program Number: V083

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