Management of Bouveret's syndrome

Abdallah, Mohamed; Atiq, Muslim; Kushnir, Vladimir; Das, Koushik K.; Doyle, Maria B. Majella; Chapman, William C.; Khan, Adeel

doi:10.1111/1751-2980.12713

Cited by 5 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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

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.

show abstract

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

“…Sin embargo, a pesar de algunos informes de éxito, el 90% de los pacientes tendrán que someterse a una laparotomía para el tratamiento definitivo. 8 El tamaño del cálculo biliar también es un factor importante a considerar porque especialmente los cálculos de más de 2,5 cm son difíciles de eliminar por vía endoscópica y también pueden impactarse en el esófago. Otros riesgos del tratamiento endoscópico incluyen la hemorragia o perforación de la pared intestinal durante la extracción del cálculo.…”

Section: Discussionunclassified

Síndrome de Bouveret: causa inusual de íleo biliar

Calvo

Franco

Lacamara

et al. 2020

Rev Fac Cien Med Univ Nac Cordoba

View full text Add to dashboard Cite

Introducción: El síndrome de Bouveret consiste en una obstrucción de la salida gástrica debido a la impactación de un cálculo biliar en el bulbo duodenal después de la migración a través de una fístula colecistoduodenal. Caso Clínico: Paciente con cuadro de dolor abdominal difuso de tipo cólico, diarreas y vómitos de aspecto amarillento. Las pruebas de imagen realizadas ponen de manifiesto una importante dilatación gástrica y duodenal con presencia de gas a nivel vesicular con la existencia de una fistula colecistoduodenal con una imagen redondeada intraluminal en yeyuno proximal compatibles con litiasis migrada. El paciente fue intervenido de urgencia mediante una enterotomía con la extracción del calculo y cierre de la misma. Discusión: El síndrome de Bouveret es una condición poco común de íleo biliar que causa una morbilidad y mortalidad significativa y, a menudo, ocurre en ancianos con comorbilidades importantes. Se requieren estrategias de diagnóstico y tratamiento individuales para un manejo y resultado óptimos, siendo el tratamiento endoscópico o la cirugía por vía abierta los dos tratamientos disponibles para la resolución del cuadro. Conclusión: El síndrome de Bouveret es una afección potencialmente mortal con obstrucción de la salida gástrica causada por cálculos biliares grandes. En la mayoría de los casos, se requiere una tomografía computarizada para su diagnóstico y si bien en algunos casos, los tratamientos percutáneos y endoscópicos pueden tener éxito como tratamiento de primera línea, la mayoría de los pacientes precisan de una cirugía para la extracción de cálculos.

show abstract

“…About 42% of patients in whom endoscopic stone removal is attempted, end up in surgical management. The current treatment of choice for biliary ileus is enterolithotomy combined with exploratory laparotomy to assess the duodenum and small intestine and colon [1,[8][9][10][11]18,19].…”

Section: Discussionmentioning

confidence: 99%

“…In unstable patients, delayed cholecystectomy is performed being the preferred behavior in most cases [20], since the combination of the two procedures in one surgery is reflected in increased mortality of up to 35%; however, when the fistula remains, it favors the recurrence of the biliary ileus or the appearance of cancer with a frequency of up to 15%. [8,9,12,14,15,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Bouveret Syndrome Resolved by a Two-Staged Endoscopic and Surgical Approach

Rb¹,

Ca²,

Bizueto-Rosas³

et al. 2020

J Surg Open Access

View full text Add to dashboard Cite

Introduction: Among the rare complications of cholecystitis is gallstone ileus and the least common is Bouveret syndrome, more frequent in older women. The diagnosis is fortuitous in most cases, so in patients with intestinal occlusion and medical history of cholecystitis, it should be considered as a possibility. The ideal treatment remains controversial. Case:We present a 93-year-old patient, with intestinal occlusion symptoms and confirmed with Bouveret syndrome after endoscopic diagnosis, with unsuccessful initial treatment and subsequently resolved with open surgery through a jejunal enterotomy with stone extraction and good postoperative evolution.Discussion: Clinically, these patients present with nonspecific symptoms such as vomiting, nausea, abdominal pain, and evidence of upper Gastrointestinal (GI) bleeding. Abdominal Computed Tomography (CT) scan is the reference diagnostic study. Endoscopy can be in some cases both diagnostic and therapeutic; the vast majority of cases are resolved with open surgery in one or two stages depending on the patient's condition. Laparoscopic surgery can be beneficial but requires a mini-laparotomy to remove large stones. Conclusion:The diagnosis of Bouveret syndrome requires a high index of suspicion in those patients with a history of cholelithiasis and symptoms of intestinal occlusion. There is the option of definitive diagnosis and treatment through endoscopic procedures, but these require the availability of diverse instruments and operator experience. For those cases with stones larger than 2.5 cm, a first intention open surgery approach is recommended.

show abstract

Management of Bouveret's syndrome

Cited by 5 publications

References 7 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

Síndrome de Bouveret: causa inusual de íleo biliar

Bouveret Syndrome Resolved by a Two-Staged Endoscopic and Surgical Approach

Contact Info

Product

Resources

About