Endoscopic Treatment of Bouveret Syndrome with Combined Laser and Mechanical Lithotripsy: A Case Report

Background: Bouveret syndrome is a complication of cholelithiasis, characterized by the migration of a large gallstone from the gallbladder to a part of the stomach or intestine through a bilio-enteric fistula. This condition results in a rare form of gallstone ileus, presenting signs and symptoms of gastric outlet obstruction. Methods: This case report aims to present a rare instance of Bouveret syndrome in a 64-year-old woman who presented to our emergency department with recurrent epigastric pain and vomiting for over 2 months. After a CT scan, an esophagogastroscopy was performed following a multidisciplinary discussion. An endoscopic evaluation revealed a large (4 cm) gallstone found in the proximal duodenum using an endoscope. We then inserted the holmium laser fiber system through a standard ERCP catheter, passing it through the endoscope's working channel. By positioning the holmium laser fiber within the catheter, we stabilized the energy on the gallstone, which was then fragmented into smaller pieces after administering pulse energy. Results: In this case report, we successfully treated Bouveret syndrome using endoscopic laser lithotripsy combined with mechanical lithotripsy, avoiding traditional surgery. Conclusions: The endoscopic approach that combines laser and mechanical lithotripsy appears effective in fragmenting large gallstones into smaller pieces, facilitating their passage through the digestive tract and resolving the obstruction.