Bouveret Syndrome: A Systematic Review of Clinical Factors Associated With Surgical Management

Bouveret syndrome is a rare form of gallstone ileus characterized by the formation of a cholecystoenteric fistula and subsequent gallstone migration into the gastrointestinal tract, resulting in gastric outlet obstruction. Diagnostic criteria consist of clinical evidence (persistent non-bilious vomiting, nausea, epigastric pain) paired with imaging (CT abdomen showing ectopic gallstone, gastric outlet obstruction, cholecystoenteric fistula) and endoscopy. Current expert consensus recommends initial endoscopic stone removal as first-line therapy to avoid techniques associated with higher morbidity and mortality. This review focuses on identifying recurrent findings in clinical and stone-related factors observed in endoscopic failure to determine any features that may guide initial therapy selection. This systematic review analyzed 30 published case reports with 31 patients, consisting of only patient-level clinical data from studies in English. Data was extracted via full-text review, organized into comparative tables, and analyzed for common patterns in symptoms, diagnostic techniques, and stone size in failed endoscopic and successful endoscopic cases. Patients ranged in age from 31 to 92 years and were predominantly female. Therapeutic endoscopic management was attempted initially in 21 cases, with successful extraction in 7 cases. The remaining 14 cases required conversion to open surgical intervention. The mean stone size did not differ substantially between successful and failed endoscopic cases. In this review, stone size did not successfully predict endoscopic success. Bouveret syndrome is a challenging condition to both diagnose and manage, with a high rate of endoscopic failure. Minimally invasive approaches in endoscopy and lithotripsy are appropriate initial strategies in selected patients; however, a substantial proportion ultimately require more open surgical intervention. Consideration of open surgical management may be warranted in patients with more severe obstruction or advanced disease, highlighting the importance of individualized treatment and standardized reporting.