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. 2017:37:45-47.
doi: 10.1016/j.ijscr.2017.06.015. Epub 2017 Jun 15.

Successful endoscopic treatment of gastric phytobezoar: A case report

Ippazio Ugenti  1 , Elisabetta Travaglio  2 , Elpiniki Lagouvardou  3 , Onofrio Caputi Iambrenghi  4 , Gennaro Martines  5
Affiliations

Successful endoscopic treatment of gastric phytobezoar: A case report

Ippazio Ugenti et al. Int J Surg Case Rep. 2017.

Abstract

Introduction: Gastric bezoars are a rare condition associated with situations of gastric dysmotility and prior gastric surgery, though sometimes they can present without any risk factor. We describe the first successful treatment in medical literature of a large gastric bezoar in the outpatient setting through endoscopic fragmentation.

Case presentation: A 76-year-old man was referred to our outpatient endoscopy clinic because of dyspepsia and epigastric pain. Upper GI endoscopy with a standard endoscope revealed a 10-cm-diameter gastric phytobezoar with necrotic pressure ulcer of the angulus. We fragmentized the bezoar into smaller pieces, with complete dissolution and without any complication. The patient was then promptly discharged home with a medical therapy. Follow-up endoscopy at 6 months showed the total disappearance of any residual fibers.

Discussion: Different types of bezoars are described in literature, of which phyto- and trychobezoars are the most frequent. They can be absolutely asymptomatic or can arise with epigastric pain, pressure ulcer bleeding, gastrointestinal perforation or small bowel obstruction. The treatment is debated though endoscopic removal or fragmentation with the help of Coca-Cola lavages has showed the best success rate. The main experiences in literature concern hospitalized patients or describe treatment techniques which require overnight stays. An effective and rapid treatment in the outpatient setting is described in our experience, without short- or long-term complications.

Conclusion: The endoscopic fragmentation of large gastric bezoars in the outpatient setting is safe with a good clinical course.

Keywords: Case report; Endoscopic treatment; Gastric bezoars; Outpatient setting.

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Figures

Fig. 1
Fig. 1
Upper GI endoscopy: gastric phytobezoar.
Fig. 2
Fig. 2
Phytobezoar complicatiom: necrotic pressure angulus ulcers.
Fig. 3
Fig. 3
Fragmented phytobezoar: polypectomy snare was used to fragmentize the bezoar.
See this image and copyright information in PMC

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