Bouveret Syndrome: When a Stone Cannot Pass the Pylorus

Khuwaja, Samreen; Azeem, Ahad; Semkhayev, Boris A.; Afthinos, John; Guttmann, Steven

doi:10.14309/crj.0000000000000176

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Overall, 31.7% (20/63) of cases had surgery performed as first-line treatment [ 44–58 ] and 39.7% (25/63) as second-line treatment [ 6–9 , 13–15 , 18 , 21–23 , 25–30 , 32 , 37 , 39–43 ]. 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.…”

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

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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%

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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“…It is associated with large gallstones (2-8 cm) and recurrent episodes of acute cholecystitis [5][6]. Large gallbladder stones increase intraluminal pressure, which results in ischemia of the gallbladder wall, allowing erosion through the wall and passing into the adjacent viscera [7]. The clinical presentation is variable.…”

Section: Discussionmentioning

confidence: 99%

Upper Gastrointestinal Bleeding: a Potential Precursor to Bouveret’s Syndrome

Goyes

Trivedi

2021

Cureus

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Bouveret's syndrome is a rare complication of cholelithiasis. It is characterized by a gallstone entering the intestine through a cholecystoenteric fistula, impacting the duodenum and causing gastric outlet obstruction. Rarely, it presents with hematemesis and melena. The diagnosis involves computed tomography (CT) and the treatment depends on the patient's stability, the location of the obstruction, stone size, and the fistula. Endoscopy or minimally invasive lithotripsy can be considered initially. If this fails, surgical intervention is recommended. We present a case of upper gastrointestinal bleeding (UGIB) preceding the development of Bouveret's syndrome.

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“…The non-operative treatment has endoscopic options: mechanical, laser lithotripsy, and electrohydraulic [1][2][3][4]. For stones that cannot be extracted, employing nets or baskets, lithotripsy methods, and extracorporeal shockwave therapy may be practiced to divide the stone before endoscopic extraction [1,4].…”

Section: Discussionmentioning

confidence: 99%

Bouveret’s Syndrome—an Unusual Fistula

Duarte

Traple

Prado³

et al. 2020

Indian J Surg

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Bouveret syndrome is a rare disease-a cause of gastric outlet obstruction. It represents less than 3% of cases of gallstone ileus, which is already rare-0.3-0.5% of patients with cholelithiasis. Persistent inflammation provokes the development of the fistula between the gallbladder and the duodenum and, with an elevation of the intraluminal pressure, the wall ischemia starts, enabling the gallstone entrance in the bowel. The risk factors are female, gallstones larger than 2.5 cm, and elderly. Morbidity and mortality are between 15 and 33%. Herein, we present a case of a Bouveret syndrome diagnosed by a CT scan.

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Bouveret Syndrome: When a Stone Cannot Pass the Pylorus

Cited by 7 publications

References 12 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

Upper Gastrointestinal Bleeding: a Potential Precursor to Bouveret’s Syndrome

Bouveret’s Syndrome—an Unusual Fistula

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