title: Endoscopic treatment of Bouverets syndrome in an extremely elderly patient with Holmium: YAG laser.
abstract: Bouveret's syndrome is a rare presentation of duodenal obstruction or gastric outlet obstruction caused by a large gallstone migrating through a cholecystoduodenal or choledochoduodenal fistula. Most patients are elderly and often have underlying comorbidities, complicating surgery. Endoscopic therapy should be used as first-line treatment for these patients who are not good surgical candidates. We report a case of a 98-year-old Chinese female who presented with vomiting for three days. Esophagogastroduodenoscopy and computed tomography confirmed the diagnosis of Bouveret's syndrome. The patient successfully underwent endoscopic lithotripsy with the Holmium: Yttrium- Aluminum-Garnet (Ho: YAG) laser. Ho: YAG laser lithotripsy has been used to treat Bouveret's syndrome in four case reports. It can be recommended in patients with Bouveret's syndrome who are poor candidates for surgery.
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authors.affiliation: Dr. Kuo-Liang Wei, Internal Medicine,, Chang Gung Memorial Hospital Chiayi Branch,, 6 Section West,, Chia-Po Road, Putz City,, Chia-Yi 613, Puzi 61363,, Taiwan, T: 886-5-362-1000, F: 886-5-362-3002, gwogi@adm.cgmh.org.tw.
authors.forename: Kao-Chi
authors.initials: KC
authors.lastname: Chang
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.affiliation: Dr. Kuo-Liang Wei, Internal Medicine,, Chang Gung Memorial Hospital Chiayi Branch,, 6 Section West,, Chia-Po Road, Putz City,, Chia-Yi 613, Puzi 61363,, Taiwan, T: 886-5-362-1000, F: 886-5-362-3002, gwogi@adm.cgmh.org.tw.
authors.forename: Kuo-Liang
authors.initials: KL
authors.lastname: Wei
mesh_terms: D000369:Aged, 80 and over; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000150:complications; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006695:Holmium / Q000627:therapeutic use*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D013577:Syndrome
chemical_list: D006695:Holmium