Figueiredo, L

Horta, D

Martins, A

Rafael, MA

Clinical Endoscopy

English

Repositório do Hospital Prof. Doutor Fernando Fonseca

Copyright © 2019 Korean Society of Gastrointestinal Endoscopy  1BRIEF REPORT2019 Nov 14. [Epub ahead of print]https://doi.org/10.5946/ce.2019.193Print ISSN 2234-2400 • On-line ISSN 2234-2443Treatment of Bouveret Syndrome with Electrohydraulic LithotripsyMaria-Ana Rafael, Luísa Figueiredo, David Horta and Alexandra MartinsDepartment of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, PortugalOpen AccessBouveret syndrome (BS) is a rare form of gallstone ileus in which the gallstone impacts in the duodenum. Although its treatment is surgical, endoscopic approaches have been used in severely ill patients. BS was diagnosed in a 73-year-old man with multiple co-morbidities: a cholecystoduodenal fistula and a 44-mm gall-stone in the third portion of the duodenum (D3). An upper endoscopy (UE) was performed, which revealed a gallstone occlusion (Fig. 1); we created a tunnel through the stone, culminating in its passage to the jejunum. Resolution of the occlusion and fragment migration downstream was achieved, with the largest fragment remaining in D3 (Fig. 2). On the fol-lowing day, another UE was performed to remove the residual fragments. Complete clinical resolution was achieved a few days after the procedure. Few cases of BS treated with electrohydraulic lithotripsy (EHL) have been described. Most gallstones were impacted in the bulb or in the second part of the duodenum, the larg-est being 47 mm in diameter.1 Although EHL is a laborious procedure and carries a risk of duodenal wall perforation or treatment failure, it can prevent the need for surgery.Received: September 17, 2019    Accepted: September 26, 2019Correspondence: Maria-Ana RafaelDepartment of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, IC 19, Amadora 2720-276, PortugalTel: +351-91-192-1578, Fax: +351-21-434-5566, E-mail: maria.monteiro.rafael@gmail.comORCID: https://orcid.org/0000-0001-9055-1399cc  This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Fig. 1. Electrohydraulic lithotripsy probe during the procedure.Fig. 2. Fragmented gallstone in the third portion of the duodenum. Erosions in the duodenal wall.2   Conflicts of InterestThe authors have no financial conflicts of interest.Author Contributions Conceptualization: David HortaSupervision: Alexandra MartinsWriting-original draft: Maria-Ana RafaelWriting-review&editing: Luísa FigueiredoORCIDLuísa Figueiredo: https://orcid.org/0000-0002-5792-4947David Horta: https://orcid.org/0000-0002-6529-050XAlexandra Martins: https://orcid.org/0000-0002-4807-9569REFEREnCES  1. Dumonceau JM, Devière J. Novel treatment options for Bouveret’s syndrome: a comprehensive review of 61 cases of successful endoscopic treatment. Expert Rev Gastroenterol Hepatol 2016;10:1245-1255.

Treatment of Bouveret Syndrome With Electrohydraulic Lithotripsy

Maria-Ana Rafael

Luísa Figueiredo

David Horta

Alexandra Martins

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Copyright © 2020 Korean Society of Gastrointestinal Endoscopy  241BRIEF REPORTClin Endosc  2020;53:241-242https://doi.org/10.5946/ce.2019.193Print ISSN 2234-2400 • On-line ISSN 2234-2443Treatment of Bouveret Syndrome with Electrohydraulic LithotripsyMaria-Ana Rafael, Luísa Figueiredo, David Horta and Alexandra MartinsDepartment of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, PortugalOpen AccessBouveret syndrome (BS) is a rare form of gallstone ileus in which the gallstone impacts in the duodenum. Although its treatment is surgical, endoscopic approaches have been used in severely ill patients. BS was diagnosed in a 73-year-old man with multiple co-morbidities: a cholecystoduodenal fistula and a 44-mm gall-stone in the third portion of the duodenum (D3). Esophago-gastroduodenoscopy (EGD) was performed, which revealed a gallstone occlusion (Fig. 1); we created a tunnel through the stone, culminating in its passage to the jejunum. Resolution of the occlusion and fragment migration downstream was achieved, with the largest fragment remaining in D3 (Fig. 2). On the following day, another EGD was performed to remove the residual fragments. Complete clinical resolution was achieved a few days after the procedure. Few cases of BS treated with electrohydraulic lithotripsy (EHL) have been described. Most gallstones were impacted in the bulb or in the second part of the duodenum, the larg-est being 47 mm in diameter.1 Although EHL is a laborious procedure and carries a risk of duodenal wall perforation or treatment failure, it can prevent the need for surgery.Received: September 17, 2019    Accepted: September 26, 2019Correspondence: Maria-Ana RafaelDepartment of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, IC 19, Amadora 2720-276, PortugalTel: +351-91-192-1578, Fax: +351-21-434-5566, E-mail: maria.monteiro.rafael@gmail.comORCID: https://orcid.org/0000-0001-9055-1399cc  This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Fig. 1. Electrohydraulic lithotripsy probe during the procedure.Fig. 2. Fragmented gallstone in the third portion of the duodenum. Erosions are observed on the duodenal wall.242   Conflicts of InterestThe authors have no financial conflicts of interest.Author Contributions Conceptualization: David HortaSupervision: Alexandra MartinsWriting-original draft: Maria-Ana RafaelWriting-review&editing: Luísa FigueiredoORCIDLuísa Figueiredo: https://orcid.org/0000-0002-5792-4947David Horta: https://orcid.org/0000-0002-6529-050XAlexandra Martins: https://orcid.org/0000-0002-4807-9569REFEREnCES  1. Dumonceau JM, Devière J. Novel treatment options for Bouveret’s syndrome: a comprehensive review of 61 cases of successful endoscopic treatment. Expert Rev Gastroenterol Hepatol 2016;10:1245-1255.

Treatment of Bouveret Syndrome with Electrohydraulic Lithotripsy

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Treatment of Bouveret Syndrome With Electrohydraulic Lithotripsy

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Repositório do Hospital Prof. Doutor Fernando Fonseca

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