Endoscopic lithotripsy for Bouveret syndrome complicated by small bowel obstruction secondary to gallstone fragments

Goonawardhana, Dulani; Huynh, Roy; Rabindran, Joel; Becerril-Martínez, Guillermo

doi:10.1093/jscr/rjab118

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…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 ]. Three of the five most serious complications (Clavien Dindo Classification 4a, 4b, or 5) occurred in patients in whom surgery was performed as second-line treatment and endoscopic therapy had failed [ 6 , 22 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…By defining a >50% chance of endoscopic success as an actual prediction of success, we evaluated the accuracy of the predictive tool in correctly predicting both the successful and failed outcomes of endoscopic therapies by inputting clinical details from references [ 6 ] to [ 43 ] into the tool. We found that the predictive tool accurately predicted endoscopic outcomes in 35/43 cases (81.4%).…”

Section: Resultsmentioning

confidence: 99%

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

Swift

Ong

Zhou

et al. 2021

Gastroenterology Report

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Background Bouveret syndrome is characterized by gallstone impaction in the upper gastrointestinal tract causing gastric outlet obstruction. In Bouveret syndrome, endoscopic gallstone removal can avert the need for surgery. However, in cases in which endoscopic therapy is unlikely to succeed, endoscopic attempts delay definitive treatment and compound patient risks. We previously developed a model that predicts endoscopic outcomes from data derived through a systematic review. This tool uses gallstone length, site of impaction, and the number of planned methods of lithotripsy to predict the likelihood of endoscopic success with an accuracy of 81.0%. This study aimed to evaluate our tool performance in an independent, non-training data set and assess endoscopic and surgical outcomes. Methods Systematic searches of the PubMed, Scopus, and Cochrane databases were performed for articles published between 16 April 2018 and 1 June 2021. The data reported after our previous study were harvested and inputted into the tool to evaluate their ability to accurately predict outcomes when compared with actual outcomes. Results Newly collated data in fields of interest showed no significant statistical differences compared with previous training data sets. Endoscopic therapy was successful in 41.9% of cases. Gallstones of ≤4 cm had a higher chance of successful endoscopic intervention (odds ratio 6.7, 95% confidence interval 1.7–25.8, P < 0.01). Complications of surgery were reported in 29.5%; there was one fatality reported. Post hoc evaluation of our predictive tool demonstrated an AUROC score of 0.80. Conclusions We have demonstrated in an independent data set that the tool can be used to accurately predict outcomes of endoscopic therapy. Patients in whom endoscopic therapy is most likely to fail should be offered an early surgical opinion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Swift

Ong

Zhou

et al. 2021

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…Although less morbid, endoscopic stone extraction is successful in only 29% of patients [ 9 ]. Further, few patients have developed small bowel or colonic obstruction due to a stone fragment that has passed distally after endoscopic manipulation and subsequently required surgical intervention [ 10 ]. Hence, surgery remains the only option if endoscopic therapy fails or does not allow complete clearance of all calculi.…”

Section: Discussionmentioning

confidence: 99%

Mirizzi Syndrome With Bouveret Syndrome: A Rare Amalgam

Varshney¹,

Hussain²,

Selvakumar³

et al. 2022

Cureus

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Mirizzi and Bouveret syndromes are uncommon but important complications of calculous cholecystitis. Mirizzi syndrome commonly presents with jaundice due to extrinsic compression on the common bile duct by an impacted stone at the gall bladder infundibulum, whereas Bouveret syndrome presents with gastric outlet obstruction due to a large stone in the duodenum. Our case is a 65-year-old lady who presented with pain in the right upper abdomen associated with nausea and vomiting. Contrast-enhanced computed tomography and MRI of the abdomen were suggestive of calculus in the infundibulum of the gall bladder with compression over the common bile duct and a large stone in the first part of the duodenum. Upper gastrointestinal endoscopy confirmed the findings but could not retrieve the stone. Cholecystectomy with the retrieval of calculus from the infundibulum and duodenum was performed with the closure of the fistulous opening. The patient did well in the post-operative period and is doing well after nine months of follow-up. Chronic calculus cholecystitis can present in varied forms, and one should be aware of such rare complications and their management.

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Endoscopic lithotripsy for Bouveret syndrome complicated by small bowel obstruction secondary to gallstone fragments

Cited by 2 publications

References 8 publications

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

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

Mirizzi Syndrome With Bouveret Syndrome: A Rare Amalgam

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