A cost-effective method of mechanical lithotripsy for the successful endoscopic management of Bouveret syndrome

This article describes successful management of Bouveret syndrome with mechanical lithotripsy assembled from cost-effective devices.

Mechanical lithotripsy was performed for a large 4.4-cm gallstone impacted in the duodenal bulb and causing Bouveret syndrome, using biliary "salvage"-type lithotripter devices consisting of a disposable through-the-scope-type lithotripter cable (Conquest TTCL, Cook Medical, Limerick, Ireland), a disposable hot polypectomy snare, and the Soehendra lithotripter handle (Cook Medical).

The gallstone impacted in the duodenum was successfully fragmented and retrieved orally, relieving the gastric outlet obstruction. The patient recovered well and was asymptomatic at 15-month follow-up.

Endoscopic treatment of Bouveret syndrome is feasible and safe. Procedural costs can be minimized by using accessories that are cost-effective.