Gastric phytobezoars: the therapeutic experience of 63 patients in Northern China

Tennis ball cord combined with endoscopy for giant gastric phytobezoar: A case report

BACKGROUND

Due to the specificity of Chinese food types, gastric phytobezoars are relatively common in China. Most gastric phytobezoars can be removed by chemical enzyme lysis and endoscopic fragmentation, but the treatment for large phytobezoars is limited, and surgical procedures are often required for this difficult problem.

CASE SUMMARY

For giant gastric phytobezoars that cannot be dissolved and fragmented by conventional treatment, we have invented a new lithotripsy technique (tennis ball cord combined with endoscopy) for these phytobezoars. This non-interventional treatment was successful in a patient whose abdominal pain was immediately relieved, and the gastroscope-induced ulcer healed well 3 d after lithotripsy. The patient was followed-up for 8 wk postoperatively and showed no discomfort such as abdominal pain.

CONCLUSION

The combination of tennis ball cord and endoscopy for the treatment of giant gastric phytobezoars is feasible and showed high safety and effectiveness, and can be widely applied in hospitals of all sizes.

Endoscopic lithotripsy combined with drug lithotripsy vs. drug lithotripsy for the treatment of phytobezoars: analysis of 165 cases

AIM

To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars.

METHODS

We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B).

RESULTS

The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A.

CONCLUSION

Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.

Self-made wire loop snare successfully treats gastric persimmon stone under endoscopy

BACKGROUND

Large gastric persimmon stones are generally resistant to standard endoscopic treatments. We applied an alternative endoscopic method using a hand-made snare for the treatment of large gastric phytobezoars.

AIM

To explore the clinical efficacy of a self-made wire loop snare to treat giant gastric persimmon stones.

METHODS

A retrospective study evaluated the clinical data of 38 patients with gastroliths admitted to Taihe Hospital in Shiyan City, Hubei Province, China, between March 2015 and October 2020. The patients were divided into observation (n = 23) and control (n = 15) groups. Patients in the observation group were treated with self-made wire loop snares for lithotripsy, and patients in the control group were treated with traditional foreign body forceps, snares, injection needles, and other tools. Successful stone removal, treatment time, and hospital stay were compared.

RESULTS

The average operating time was significantly shorter (P < 0.001) in the observation group (53.4 min) than that in the control group (172.8 min). The average hospital stay of the observation group (5.4 d) was significantly shorter (P < 0.001) than that in the control group (10.3 d). Successful one-time treatment was significantly more frequent (P < 0.001) in the observation group (87%) than in the control group (7%).

CONCLUSION

Self-made guidewire loop snares were successfully used to treat gastrolithiasis, and were significantly more effective than foreign body forceps, snares, and other traditional methods.

Esophageal pharmacobezoar: a very unusual complication of enteral nutrition use

Enteral nutrition in intensive care has been a great advance in medicine, due to its benefit, cost-effectiveness and few complications. Bronchoaspiration, diarrhea, regurgitation or mechanical problems are the main adverse effects. Esophageal obstruction by bezoar is a very infrequent complication, and there are only a few cases described in the literature.