How good is cola for dissolution of gastric phytobezoars?

Abstract

Aim: To evaluate the efficacy of cola treatment for gastric phytobezoars, including diospyrobezoars.

Methods: A total of 17 patients (range: 48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuvant endoscopic therapy were reviewed. Three liters of cola lavage (10 cases) or drink (7 cases) were initially used, and then endoscopic fragmentation was done for the remnant bezoars by using a lithotripsy basket or a polypectomy snare. The overall success of dissolving a gastric phytobezoars with using three liters of cola and the clinical and endoscopic findings were compared retrospectively between four cases of complete dissolution by using only cola and 13 cases of partial dissolution with cola.

Results: After 3 L of cola lavage or drinking, a complete dissolution of bezoars was achieved in four patients (23.5%), while 13 cases (76.5%) were only partially dissolved. Phytobezoars (4 of 6 cases) were observed more frequently than diospyrobezoars (0 of 11) in the group that underwent complete dissolution (P = 0.006). Gender, symptom duration, size of bezoar and method of cola administration were not significantly different between the two groups. Twelve of 13 patients with residual bezoars were completely treated with a combination of cola and endoscopic fragmentation.

Conclusion: The rate of complete dissolution with three liters of cola was 23.5%, but no case of diospyrobezoar was completely dissolved using this method. However, pretreatment with cola may be helpful and facilitate endoscopic fragmentation of gastric phytobezoars.

Figure 1

Endoscopic views of diospyrobezoar. A: Initial endoscopic view. A huge dark brownish-colored diospyrobezoar was noted in the stomach (case 8). B: Endoscopic view of one day after 3 L of cola lavage. The size of bezoar was decreased. C: Endoscopic procedure.The remnant bezoar was captured and fragmented into four pieces by basket. D: Endoscopic procedure. The fragmented bezoar was crushed and retrieved by grasping force.

Figure 2

Endoscopic views of huge diospyrobezoar. A: Initial endoscopic view. Endoscopic view of huge dark brownish colored diospyrobezoar in the stomach (Case 17). B: Endoscopic view of one day after 3 L of cola lavage. The size was decreased and some fragmentation was observed. C: Endoscopic view of 4th day. The residual bezoar still remained with fragmentation (total amount of administrated cola was 9 L).