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

Background and Aims: This article describes successful management of Bouveret syndrome with mechanical lithotripsy assembled from cost-effective devices. Methods: 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). Results: 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. Conclusions: Endoscopic treatment of Bouveret syndrome is feasible and safe. Procedural costs can be minimized by using accessories that are cost-effective.