Novel Technique for Management of Bulvard Syndrome. Jones presentation. A seven, six-year-old male history of coronary artery disease with percutaneous coronary intervention, pacemaker, and diabetes presented to occupational health and safety with sudden onset of abdominal pain and vomiting. The CT abdomen scan showed a 3.0 centimeters gallstone in the sending duodenum and intraepatic biliary air, indicating a bilioenteric fistula. Diagnosis of Bulvard Syndrome was made. The Bulvard Syndrome is a heart-cholelithiasis complication with bilioenteric fistula and gallstone migration, promoting gastric outlet obstruction symptoms. Endoscopic methods to approach it. EGD with reveal cap to identify the gallstone location. Eisner mechanical lithotripsy to perform it, the stone into smaller pieces. A rough net to retrieve it into the stomach with gentle maneuvering. The endoscopic mechanical lithotripsy with snare, basket, and also electrolyte lithotripsy to fragment it. Adapted overtube assistance to remove the fragments. You can see at the stomach the reveal cap at the EGD and also the impacted gallstone at the pylorus. We used the snare to fragment it with Eisner in order to make the gallstone a smaller one. We used then a rough net to retrieve the gallstone into the stomach. We then put the stone in the stomach. We perform the electrohydraulic lithotripsy. Due to the unstable positioning and gallstone mobility, the lithotripsy was not so efficient. We then tried to remove it with the rough net cap. There was a upper esophageal sphincter impactation of the gallstone. We then adapted an overtube placement with a flat adaptation of the tip of the overtube. We can see at the retrovision the overtube positioning in good position and also the flat. We tried also a mechanical fragmentation with basket. we had a broken handle cord of the basket because of the stone hardness we then followed with the scenario capturing of the stone with the overture flat assistance in order to remove it safely that was the complete removal of the stone applications. Endoscopy for Beaufort syndrome is a well-tolerant treatment option the use of a reveal cap helps to better identify large objects through narrow structures such as the pylorus. Mechanical lithotripsy with the scenarios is feasible and the basket may also break at the handle cord. Electrohydraulic lithotripsy has better results with impacted stones. The overture adaptation with flap on the tip helps to fit the stone inside and also to remove it safely through the upper esophageal sphincter Conclusions Beaufort syndrome is a hierarchical disease complication with biliataric fistula and gallstone migration promoting gastric outlet obstruction symptoms. Endoscopy is a first-line therapy indicated for elderly and multi-comorbidities patients with lower morbidity and mortality than sanitary. Thank you

Novel Technique for Management of Bulvard Syndrome

Jones

case study

Bulvard syndrome

endoscopic methods