Novel treatment options for Bouveret's syndrome: a comprehensive review of 61 cases of successful endoscopic treatment.
In Bouveret's syndrome, a biliary stone obstructs the duodenum. Surgical treatment is plagued by high morbidity and mortality. Therefore, endoscopic treatment has become a first-line approach. Areas covered: A literature search of Medline and Google Scholar databases was performed using the terms endoscopic treatment, non-operative treatment, Bouveret's syndrome, and gallstone ileus. Sixty-one cases of successful endoscopic treatment were found over the period 1978-2016 and are summarized herein. Therapeutic modalities used in 52 patients with complete success included mechanical lithotripsy (40% of cases), electrohydraulic lithotripsy (21% of cases), extraction of the intact stone and laser lithotripsy (15% of cases each), extracorporeal shockwave lithotripsy and duodenal stenting (4% of cases each). In the remaining 9 patients, stone fragments migrated distally and required surgical removal. Cholecystectomy was performed in five (8.2%) of 61 patients and gallbladder cancer was detected in three (4.9%) patients. Expert commentary: Meticulous preparation, including that of instruments, personnel, patient anesthesia, and X-ray availability, is key to success in this unusual situation. Partial success (stone fragmentation and mobilization to another location) may render surgery easier as these patients present with dense adherences in the right upper quadrant. Cholecystectomy is reserved for highly selected patients (e.g. relapsing ileus, gallbladder cancer).
a Gedyt Endoscopy Center , Buenos Aires , Argentina.
Jean-Marc
JM
Dumonceau
b Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital , Université Libre de Bruxelles , Brussels , Belgium.
Jacques
J
Devière
D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013577:Syndrome; D016896:Treatment Outcome
Bouveret’s syndrome; Gallstone ileus; cholecystoduodenal fistula; electrohydraulic lithotripsy; extracorporeal shockwave lithotripsy; gastric outlet obstruction; laser lithotripsy; mechanical lithotripsy