Endoscopic management of huge bezoars

Abstract

Background and study aims: After the first gastroscopic removal of a bezoar by McKechne in 1972, different endoscopic methods have been reported including a water jet, forceps, snare, and basket. Huge and solid bezoars, however, are still a problem. We report on our experience in fragmenting huge, solid bezoars using a modified needle-knife (bezotome) and a modified mechanical lithotriptor (bezotriptor).

Patients and methods: Over a period of 14 months (October 1994 to December 1995), a total of 15 patients (ten male, five female, median age 41 years) with 17 gastric bezoars and one esophageal bezoar, treated endoscopically, were included in the study. A monopolar diathermy knife with a 15 mm needle (bezotome) was used for trichobezoars. For diospyrobezoars we need a bezotriptor.

Results: All 18 bezoars, from 4 x 3 x 3 cm to 10 x 8 x 8 cm in size, were successfully fragmented, ten in one session and eight in two sessions. Complete clearance of the upper digestive tract was achieved at the latest three days after the treatment. There were no complications.

Conclusions: Bezotome and bezotriptor are useful endoscopic devices to disintegrate huge, hard bezoars and achieve complete clearance.