SP 9.01 Endoscopy or Surgical Enterolithotomy? A Review of Management Strategies for Bouveret Syndrome
Anna Murray, Dorothy Johnston, Lauren Thompson, John Eccles, Anthony McBreartyAbstract
Aim
Bouveret syndrome is a rare cause of gastric outlet obstruction resulting from gallstone migration through a biliary–enteric fistula. It predominantly affects elderly, frail patients and is associated with significant morbidity and mortality. Surgical enterolithotomy has traditionally been considered definitive management; however, advances in endoscopic therapy have challenged its role as first-line treatment. This review evaluates outcomes of primary endoscopic management and its implications for surgical decision-making.
Methods
A literature review was performed using MEDLINE and Embase from 1946 to March 2025. Studies reporting cases of confirmed Bouveret syndrome managed initially by endoscopic intervention were included. Data extracted included patient demographics, endoscopic modality used, success rates, requirement for subsequent surgical enterolithotomy, and mortality. A representative institutional case is briefly referenced for clinical context.
Results
One hundred and twenty-one studies describing 125 cases were included. Patients were predominantly elderly (90% aged ≥60 years) and female (68%). Endoscopic management alone was successful in 55.2% of cases, avoiding emergency surgery. Electrohydraulic lithotripsy demonstrated the highest success rate (84%). Failed endoscopic intervention proceeded to open or laparoscopic surgical enterolithotomy, with or without fistula repair or cholecystectomy. Mortality within the endoscopically managed cohort was low, and prior endoscopic intervention did not adversely affect subsequent surgical outcomes.
Conclusions
Primary endoscopic management represents an effective risk-reduction strategy in Bouveret syndrome. Surgical enterolithotomy remains definitive for failed cases but should be reserved for selected patients within a multidisciplinary, stepwise management approach.