Endoscopic treatment for Bouveret syndrome

Article (PDF Available)inSurgical Endoscopy 27(2) · October 2012with26 Reads
DOI: 10.1007/s00464-012-2533-8 · Source: PubMed
Abstract
Background: 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. Endoscopic techniques continue to evolve, allowing for more complex procedures and avoidance of open surgery and its accompanying high morbidity. This video displays a rarely used endoscopic method of relieving gastric outlet obstruction caused by a stone in a patient with Bouveret syndrome. Methods: Video of successful endoscopic retrieval of a gallstone lodged in the pylorus is presented. An endoscopic retrieval basket is used, and key maneuvers highlighted include passage of the closed device distal to the stone, opening of the basket, and withdrawal 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. Liver function tests were normal postoperatively, so no further evaluation of the bile duct was necessary. Conclusions: With new advances in technology, the endoscopic approach should be considered as the first line of treatment for cases of Bouveret syndrome because most patients are elderly with multiple comorbidities.
VIDEO
Endoscopic treatment for Bouveret syndrome
Jin-cheng Zhao
Ermilo Barrera
Mohammad Salabat
Woody Denham
Dennis Leung
Michael Ujiki
Received: 22 February 2012 / Accepted: 30 July 2012 / Published online: 10 October 2012
Ó Springer Science+Business Media, LLC 2012
Abstract
Background 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 [4]. 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 [13, 57]. Endoscopic
techniques continue to evolve, allowing for more complex
procedures and avoidance of open surgery and its accom-
panying high morbidity. This video displays a rarely used
endoscopic method of relieving gastric outlet obstruction
caused by a stone in a patient with Bouveret syndrome.
Methods Video of successful endoscopic retrieval of a
gallstone lodged in the pylorus is presented. An endoscopic
retrieval basket is used, and key maneuvers highlighted
include passage of the closed device distal to the stone,
opening of the basket, and withdrawal 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 chole-
cystoduodenal fistulae are large and will spontaneously close,
especially if a patent cystic duct is present. Liver function tests
were normal postoperatively, so no further evaluation of the
bile duct was necessary.
Conclusions With new advances in technology, the
endoscopic approach should be considered as the first line
of treatment for cases of Bouveret syndrome because most
patients are elderly with multiple comorbidities.
Keyword Gallstone ileus Endoscopy Bouveret
syndrome
Disclosures Drs. Jin-cheng Zhao, Ermilo Barrera, Mohammad
Salabat, Woody Denham, Dennis Leung, and Michael Ujiki have no
conflicts of interest or financial ties to disclose.
References
1. Ariche A, Czeiger D, Gortzak Y, Shaked G, Shelef I, Levy I
(2000) Gastric outlet obstruction by gallstone: Bouveret syndrome.
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2. Reisner RM, Cohen JR (1994) Gallstone ileus: a review of 1001
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3. Sakarya A, Erhan MY, Aydede H, Kara E, Ozkol M, Ilkgu
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obstruction (Bouveret’s syndrome): a case report. Acta Chir Belg
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4. Bouveret L (1896) Stenose du pylore adhe
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5. Erlandson MD, Kim AW, Richter HM III, Myers J (2009) Roux-en-Y
duodenojejunostomy in the treatment of Bouveret syndrome. South
Med J 2(9):963–965
6. O’Neill C, Colquhoun P, Schlachta CM, Etemad-Rezai R,
Jayaraman S (2009) Gastric outlet obstruction secondary to biliary
calculi: 2 cases of Bouveret syndrome. Can J Surg 52(1):E16–E18
7. Lowe AS, Stephenson S, Kay CL, May J (2005) Duodenal
obstruction by gallstones (Bouveret’s syndrome): a review of the
literature. Endoscopy 37(1):82–87
Presented at the SAGES 2012 Annual Meeting, March 7–10, 2012,
San Diego, CA.
Electronic supplementary material The online version of this
article (doi:10.1007/s00464-012-2533-8) contains supplementary
material, which is available to authorized users.
J. Zhao E. Barrera M. Salabat W. Denham
D. Leung M. Ujiki (&)
Department of Surgery, NorthShore University HealthSystem,
Evanston, IL 60201, USA
e-mail: mujiki@northshore.org
123
Surg Endosc (2013) 27:655
DOI 10.1007/s00464-012-2533-8
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