Bouveret syndrome: A series of cases that illustrates a rare complication of chronic cholelithiasis

Bouveret Syndrome: Etiology, Clinical Presentation, Differential Diagnosis, Complications, and Treatment Options

Bouveret syndrome is one of the complications of gallstone disease possibly fatal, which proposes the presence of a large stone obliterating the lumen of the duodenum or stomach because of the formation of a bilioenteric fistula. This review article, therefore, plans to review the causes, patient characteristics, diagnostic workup, associated conditions, and treatment of Bouveret syndrome. A literature search was also performed through scientific databases such as Scopus, Google Scholar, and PubMed concerning articles related to Bouveret syndrome written by different authors. The terms employed for the search were bilioduodenal fistula, Bouveret syndrome, gastric outlet obstruction, and gallstone ileus. Both case reports and systematic reviews that were written in the English language and published between the years 2000 and 2024 were considered. Finally, the review establishes the relevant concerns surrounding the diagnosis of Bouveret syndrome, focusing on the diagnosing issues. It emphasises the need for some specialities' involvement and focuses on the importance of endoscopic intervention. For patients, endoscopy remains the first line of treatment, while surgery is necessary in cases where conservative methods cannot be used. The article also focuses on new approaches to treating the conditions, such as percutaneous gallbladder stone dissolution. Latterly, further developments in minimally invasive surgery pertain to refining methods, including endoscopic removal and lithotripsy, to improve the survival rate of patients. Further investigation is required, especially regarding the administration schedule in relation to this disorder and goals that can reduce mortality and morbidity, especially in elderly patients with comorbid diseases.

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

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.