Background and Aims Bouveret syndrome is a rare cause of gastric outlet obstruction in which a gallstone passes through a cholecystoduodenal fistula and becomes impacted in the proximal duodenum. Conventional endoscopic extraction often fails, and surgery carries a high risk. We present a novel minimally invasive approach using a flexible cryoprobe to successfully remove a large, impacted gallstone after standard techniques failed. Methods A 65-year-old woman presented with features of gastric outlet obstruction caused by a large duodenal gallstone impacting the proximal duodenum. Following resuscitation, multiple conventional endoscopic extraction techniques and electrohydraulic lithotripsy failed. A salvage endoscopic rescue technique using an externally mounted 2.4-mm cryotherapy probe achieved firm adhesion to the stone, enabling en bloc extraction into the stomach. Subsequent lithotripsy and Roth net retrieval achieved complete stone removal. Results The procedure was technically successful, with no complications. There were no immediate complications post-procedure. At 2- and 6-month follow-up, the patient remained asymptomatic and had no new concerns. Conclusions This case highlights the use of a cryoprobe for endoscopic extraction of a large, impacted duodenal gallstone causing Bouveret syndrome after conventional methods failed, suggesting a promising minimally invasive approach for difficult gallstones and other challenging gastrointestinal foreign bodies.

BACKGROUND AND AIMS:Both fully covered self-expanding metal stents (FCSEMS) and liquid nitrogen spray cryotherapy with balloon dilation (cryodilation; LNSC) are established modalities for palliating malignant esophageal disease. FCSEMS offers immediate luminal patency, while LNSC provides non-contact tissue ablation. Comparative data on clinical efficacy and safety are limited. We aimed to compare outcomes between FCSEMS and LNSC in patients with esophageal malignancy. METHODS:We conducted a retrospective cohort study of patients undergoing either FCSEMS (n=131) or cryodilation (n=38) for malignant esophageal obstruction. Clinical data included demographics, lesion characteristics, comorbidities, technical and clinical outcomes, and adverse events. Technical success was defined as successful completion of the intended procedure. Clinical success was defined as improvement or stabilization of dysphagia (Ogilvie scale), with pre- and post-procedural scores recorded. A sensitivity analysis restricted improvement to ≥1-point Ogilvie score change. Adverse events were classified by type, timing (early ≤14 days vs. late 15-30 days), and ASGE Lexicon severity. Multivariable logistic regression and a propensity score sensitivity analysis were performed to adjust for lesion location, comorbidities, disease stage, and prior therapy. A subgroup analysis was restricted to distal esophageal/GEJ lesions. RESULTS:Technical success was achieved in 100% of cases in both groups. Clinical success was observed in 86.8% of LNSC patients vs. 71.0% of FCSEMS patients (p = 0.057; OR 2.70, 95% CI 0.93-7.83). Median Ogilvie dysphagia score improved from 3 to 2 in FCSEMS (change -1, IQR 0 to -2) and from 3 to 1 in LNSC (change -2, IQR -1 to -2). Adverse events were significantly more common in the FCSEMS group (31.3% vs. 7.9%, p = 0.037; aOR 0.21, 95% CI 0.06-0.76 favouring LNSC). In the FCSEMS cohort, stent migration (19.1%) and intolerance requiring removal (7.6%) were the most frequent events, predominantly early (≤14 days). Minor bleeding (1.5%), tissue overgrowth (1.5%), and food impaction (1.5%) were infrequent. No perforations occurred in either group. In LNSC, three patients (7.9%) developed delayed stricture (late events). All complications were managed endoscopically. CONCLUSIONS:In this retrospective study, both FCSEMS and cryodilation are effective palliative options for malignant esophageal obstruction. Cryodilation was associated with fewer adverse events, while clinical success rates were comparable. Both modalities have distinct roles in a multidisciplinary palliative strategy, and prospective studies are needed to guide patient selection.

There is emerging recent data that has shown women to be more prone to in-hospital major adverse events after trans catheter left atrial appendage occlusion. Institutional LAAO registry at West Virginia University (WVU) was reviewed from January 2016 to October 2021 to identify 271 women and 293 men who underwent successful LAAO device implantation. Patients were evaluated for gender based differences in baseline characteristics, CHA2DS2-VASc Score, HAS-BLED score, procedural data, in-hospital, and follow-up outcomes. Compared to men, women had lower baseline comorbidities including coronary artery disease (135 (49.6%) vs 172 (58.7%), P = 0.03), myocardial infarction (MI) (56 (20.5%) vs 85 (29%), P = 0.02) and coronary artery bypass surgery (10 (3.6%) vs 27 (9.2%), P = 0.008). Women were noted to have a higher CHA2DS2-VASc Score (5.3 +/- 1.4 vs 4.4 +/- 1.4, P < 0.001), and left ventricular ejection fraction (57.9 +/- 7.7 vs 52.7 +/- 12.4, P < 0.001). Women were noted to have a significantly higher rate of in-hospital composite adverse events men. No statistically significant differences were noted between both genders regarding the follow-up outcome. Our single center study shows women to have higher in-hospital composite adverse events as well as higher bleeding events during the index hospital admission. (Curr Probl Cardiol 2023;48:101532.)