Bouveret’s Syndrome – Case Series with Therapeutic Implications

Abstract

Bouveret’s syndrome is a rare complication resulting from gallstone disease. Both surgical and endoscopical procedures are performed, with the disease to be seen as strictly interdisciplinary. There are no well-established recommendations for this condition. In this paper, we want to describe our experience from 6 cases in 3 Swiss hospitals from 2015 to 2017 with emphasis on the endoscopic technique of electrohydraulic lithotripsy followed by balloon dilatation and propose a treatment algorithm.

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

“…The median stone sizes for patients undergoing first-line surgical therapy and second-line surgical therapy were 40 mm (IQR 30–58 mm) and 50 mm (IQR 40–60 mm), respectively; the difference between both groups was not statistically significant ( P = 0.16); 96.8% (30/31) of cases that underwent laparotomy were successful (defined as relief of mechanical obstruction and discharged from hospital), whereas 27.3% (3/11) of laparoscopic cases required conversion to laparotomy. Three cases did not specify whether surgery was via a laparoscopic or open approach [ 18 , 27 , 29 ]. Complications (categorized according to the Clavien Dindo Classification; Supplementary Table 3 ) were reported in 29.5% (13/44) of surgical cases [ 6 , 8 , 18 , 22 , 41 , 43 , 44 , 46 , 47 , 50 , 59 , 61 ], including one post-operative fatality [ 61 ].…”

“…Outcomes of endoscopic therapy are summarized in Table 2 . Of the 43 cases in which endoscopic therapy was attempted [ 6–43 ], 18 were successful (41.9%) [ 10–12 , 16 , 17 , 19 , 20 , 22 , 24 , 29 , 31 , 33–36 , 38 ]. Gallstones ≤4 cm in size were associated with a higher chance of successful endoscopic intervention than those >4 cm [odds ratio (OR) 6.7, 95% CI 1.7–25.8, P < 0.01].…”