# Bouveret Syndrome: A Surgery-Sparing Endoscopic Approach

## TL;DR

This paper presents a case where endoscopic techniques were used instead of surgery to treat a rare gallstone complication in a high-risk patient.

## Contribution

The novel contribution is demonstrating a surgery-sparing endoscopic approach for Bouveret syndrome in a medically complex patient.

## Key findings

- Endoscopic techniques successfully managed a large obstructing gallstone in a high-risk patient.
- Conservative management resolved a duodenal perforation without surgical intervention.
- The approach reduced surgical risks and achieved successful recovery.

## Abstract

Cholelithiasis is a common condition, and complications of gallstone disease include cholecystitis, cholangitis, pancreatitis, and, rarely, gallstone ileus or Bouveret syndrome. We present a case of a 79-year-old male with multiple comorbidities who was treated using endoscopic techniques to avoid the risks associated with surgery. The approach utilized holmium laser lithotripsy and electrohydraulic lithotripsy over multiple sessions to fragment and remove the large gallstone causing a duodenal obstruction. Conservative management of a subsequent duodenal perforation led to successful recovery. This case highlights the potential for endoscopic methods to manage gallstone ileus in high-risk patients, reducing complications and potentially avoiding surgery.