Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome)
Figure 3
Two different lithotripters were used to fragment the stone. (a) Holmium: YAG laser produced small cracks on the proximal surface (arrows) but the majority of the stone still remained impacted. (b) Electrohydraulic lithotripsy (IEHL) successfully shattered the outer “shell” of the stone (white arrow) and left behind a smaller, much harder core (black arrow). (c) Ultimately, the majority of the stone was fragmented after extensive use of both lithotriptors.
