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Piero V. Valli1, Reto Bertolini2, Jan Borovicka3, Christoph Gubler1*

1Division of Gastroenterology and Hepatology, Zurich University Hospital, Switzerland 2Division of Gastroenterology, Kantonsspital Winterthur, Switzerland
3Division of Gastroenterology, Kantonsspital St. Gallen, Switzerland

Background and Study Aims: Bouveret’s syndrome describes gastric outlet obstruction caused by a perforated gallstone fol- lowing a cholecystoduodenal or a choledochoduodenal fistula. Biliary stones leading to gastric outlet obstruction are typically large making classic stone retrieval or destruction very challenging and time-consuming. We here present the first two cases of Bouveret’s syndrome successfully undergoing the novel drill and blast technique.
Materials and Methods: After drilling a channel through the obstructing biliary stone by Electrohydraulic Lithotripsy (EHL), a balloon dilatation catheter was then guided through the drill channel. Balloon dilatation was then performed within the biliary stone and allowed stone fragmentation and retrieval.
Patients & Results: Two patients presenting with nearly complete gastric outlet obstruction underwent the drill and blast ma- neuver for Bouveret’s syndrome. Gastroduodenal passage was successfully restored, and oral fluid and food intake was resumed in both patients. No adverse events were observed during a follow up of 30 days.
Conclusions: We suggest that drill and blast is a feasible and promising variant of EHL for large and impacted gall stones in Bouveret’s syndrome.