Clinical Endoscopy

Migration of a Percutaneous Endoscopic Gastrojejunostomy Tube into the Colon with Small Intestinal Telescoping: Shinya Taki, Takao Maekita, Mayumi Sakata, Kazuhiro Fukatsu, Yoshimasa Maeda, Mikitaka Iguchi, Hidefumi Ito, Masayuki Kitano; Clin Endosc 2019;52(6):616-619. Published online October 16, 2019; DOI: https://doi.org/10.5946/ce.2019.016

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.

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Retrograde Migration of a Percutaneous Endoscopic Gastro-Jejunal Tube Into the Esophagus
Binyamin R Abramowitz, Jude Noel, Sushil Ahlawat
Cureus.2024;[Epub] CrossRef
Weighted Tip Extensions Result in Fewer Gastrojejunostomy Tube Migrations and Increase Tube Lifespan
Matthew A. Patetta, Kyung R. Kim, Clayton W. Commander, Peter R. Bream
Journal of Vascular and Interventional Radiology.2023; 34(1): 124. CrossRef
Understanding Parkinson's Disease: A Basic Overview
Rachael L Anderson, Adelene Choo, Sue Sharrad, Ruth Withey
Australasian Journal of Neuroscience.2023; 33(2): 9. CrossRef
Parkinson hastalarında perkütan endoskopik gastrojejunostomi katateri takılan hastalarımızın takibi: Tek merkez deneyimi
Nurten TÜRKEL KÜÇÜKMETİN, Tevfik SOLAKOĞLU
Akademik Gastroenteroloji Dergisi.2022; 21(3): 157. CrossRef

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Megaduodenum with Duodenal Diospyrobezoars: Hyun Woo Park, Hyun Seok Lee; Clin Endosc 2015;48(5):436-439. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.436

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Bezoars are retained masses of ingested materials accumulating within the gastrointestinal track. While gastric bezoars are often observed, duodenal bezoars are rarely reported. A 77-year-old man who had frequently consumed persimmons and had never undergone gastric surgery had symptoms of epigastric pain and early satiety for 10 days. Esophagogastroduodenoscopy showed many diospyrobezoars in a severely distended duodenal bulb, otherwise known as megaduodenum. The patient's treatment consisted of repeated endoscopic removal of the bezoars by using a retrieval net.

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Case Report: A Child With Functional Chronic Duodenal Obstruction Caused by Megaduodenum
Zhibo Qu, Biao Zheng, Chuncheng Ju, Jiaxu Liu, Bingyang Liu, Haoran Zhang
Frontiers in Pediatrics.2021;[Epub] CrossRef
A rare case of idiopathic congenital megaduodenum in adult misinterpreted during childhood: case report and literature review
Natally Horvat, Vicente Bohrer Brentano, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Publio Cesar Cavalcante Viana, Marcel Cerqueira Cesar Machado
Radiology Case Reports.2019; 14(7): 858. CrossRef

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A Large-Sized Phytobezoar Located on the Rare Site of the Gastrointestinal Tract: Jee Eun Yang, Ji Yong Ahn, Gi Ae Kim, Ga Hee Kim, Da Lim Yoon, Sung Jin Jeon, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2013;46(4):399-402. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.399

Abstract PDF PubReader ePub

Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7×8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.

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Citations to this article as recorded by

Unveiling a Silent Obstructor: Phytobezoar in the Third Duodenal Segment
Ana Fernanda Muñoz Durán, Juan Alberto Llanos Visbal, Leidy Vanessa Aguirre Carvajal, Juan Daniel Ayala Torres, Nicolás Álvarez Gärtner, Julián Andrés Muñoz Durán
Prague Medical Report.2024; 125(2): 146. CrossRef
An Unusual Presentation of Crohn’s Disease Diagnosed Following Accidental Ingestion of Fruit Pits: Report of Two Cases and Review of the Literature
Emanuele Sinagra, Dario Raimondo, Salvatore Marco Iacopinelli, Francesca Rossi, Giuseppe Conoscenti, Maria Angela Di Maggio, Sergio Testai, Rita Alloro, Marta Marasà, Alberto Calandra, Claudia Costanza, Serena Cristofalo, Socrate Pallio, Marcello Maida, I
Life.2021; 11(12): 1415. CrossRef
Afferent Loop Obstruction after Gastric Cancer Surgery Due to a Bezoar Comprised Mainly of Calcium Stearate
Kenta Katsumata, Takeharu Enomoto, Takehito Otsubo, Masaki Hiwatari, Yoshitsugu Tsukamoto, Natsuko Kamei, Jin Shimada, Shinjiro Kobayashi, Kazuhiro Ashikawa, Shinya Mikami
The Japanese Journal of Gastroenterological Surgery.2020; 53(6): 481. CrossRef
Fitobezoar posterior a mini bypass gástrico por laparoscopia
Rey J. Romero, Laura Martínez, Isidro R. Villegas Villegas
Revista Colombiana de Cirugía .2019; 34(3): 283. CrossRef
An unexpected guest in the duodenal ampulla: Tales apart from Rapunzel
Fatih Saygili, Erkin Oztas, Mahmut Yuksel, Yusuf Ozogul
Geriatrics & Gerontology International.2017; 17(2): 349. CrossRef
Obstructive Bezoars of the Small Bowel Treated with Coca-Cola Zero through a Long Intestinal Tube and Endoscopic Manipulation
Kei Endo, Keisuke Kakisaka, Yuji Suzuki, Takayuki Matsumoto, Yasuhiro Takikawa
Internal Medicine.2017; 56(22): 3019. CrossRef
Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings
Lian-qin Kuang, Da-wei Zhao, Cheng Cheng, Yi Wang
BioMed Research International.2016; 2016: 1. CrossRef
Megaduodenum with Duodenal Diospyrobezoars
Hyun Woo Park, Hyun Seok Lee
Clinical Endoscopy.2015; 48(5): 436. CrossRef

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A Case of Gastric Bezoar Treated with a Distal Attachment Device: Kwang Pyo Jang, M.D., Jun Lee, M.D., Il Goo Park, M.D., Yu Mi Byeon, M.D., Chol Jin Park, M.D., Young Dae Kim, M.D., Chan Guk Park, M.D. and Man Woo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(4):232-235. Published online April 28, 2011

Abstract PDF: Bezoars are collection of indigestible materials in the gastrointestinal tract. Many endoscopic techniques for removal of bezoars have been reported recently, but these methods need much equipment. We treated a gastric bezoar with a distal attachment device easily available for an endoscope. A 74-year-old man with a history of diabetes mellitus was admitted to hospital with hematemesis. On the second endoscopic examination, a gastric bezoar (6×4×4 cm) was detected in the stomach. Then, using a distal attachment device, we injected Coca-Cola directly into the bezoar by an injector. With tension force, the bezoar was easily broken due to the impulse of the distal attachment device. The endoscopic technique used in our case can be easily performed and has fewer complications compared to those of other techniques. Therefore, we report here on this new treatment modality that uses a distal attachment device. (Korean J Gastrointest Endosc 2011;42:232-235)

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A Case of Colonic Obstruction Due to Phytobezoars: Jung Min Chae, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sunyong Kim, M.D., Uk Jo, M.D., Min Kyung Kim, M.D. and Jung Sun Yoo, M.D.; Korean J Gastrointest Endosc 2011;42(1):43-46. Published online January 30, 2011

Abstract PDF: Colonic phytobezoars are defined as conglomerate masses of fruit or vegetable matter in the colon, and these have rarely reported as a cause of colon obstruction. Because it is extremely rare, its correct diagnosis might be delayed even with the aid of abdominal computed tomography. We report here on a case of diagnosed colonic obstruction due to colonic phytobezoars in a 67-year-old female with diabetic end stage renal disease and chronic constipation. Although abdomino-pelvic computed tomography did not demonstrate the presence of phytobezoars, multiple phytobezoars impacted in the colon were found and these were removed by colonoscopy. This is a rare case in that colonic obstruction due to phytobezoar was diagnosed early and it was treated by colonoscopy. (Korean J Gastrointest Endosc 2011;42:43-46)

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A Case of Incidentally Found Primary Esophageal Bezoar in a Patient with Situs Inversus Totalis: Yong Chan Cho, M.D., Won Jung Jun, M.D., Hyung Il Kim, M.D., Sung Kyun Kim, M.D., Hyen Soo Kim, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew, M.D.; Korean J Gastrointest Endosc 2010;41(1):16-20. Published online July 31, 2010

Abstract PDF: Situs inversus totalis (SIT) is very rare autosomal recessive condition, and patients with SIT have complete mirror image reversal of the thoracic and abdominal viscera. There have been no case reports of esophageal bezoar in a patient with situs inversus totalis. Bezoars are retained concretions of indigestible foreign material, including food material, vegetable material and hair, and they are usually founded in the stomach, small intestine and rectum. Esophageal bezoars are very rare, but they are known to occur in patients with anatomical defects or esophageal motility disorders. The treatment of esophageal bezoar is usually based on endoscopic fragmentation and extraction, dissolution with papain, cellulose, pancreatic enzyme and/or Coca cola. We report here on a case of an endoscopically treated primary esophageal bezoar in a patient with situs inversus totalis, and the patient experienced no complications from the treatment. (Korean J Gastrointest Endosc 2010;41:16-20)

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A Huge Gastric Bezoar That Was Removed by Endoscopic Combination Therapy with an Argon Plasma and Coca-Cola Injection: Jung Hoon Kim, M.D., Won Ki Bae, M.D., Hyoung Don Lee, M.D., Jung Bok Park, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Young Soo Moon, M.D.; Korean J Gastrointest Endosc 2010;40(6):370-373. Published online June 30, 2010

Abstract PDF: Bezoars are collections or concretions of indigestible foreign material in the gastrointestinal tract. In the past, the most common method for the treatment of bezoar was surgical management. The current treatment methods for bezoars include chemical dissolution and endoscopic lithotripsy using biopsy forceps and, snare, electrohydraulic lithotripsy and laser. Cases of endoscopic fragmentation of gastric bezoars using an argon plasma and dissolution of gastric bezoars with Cola have recently been described, but it took a long time in those cases to remove a bezoar by a single method. Moreover, fragmented, residual bezoar-related complications sometimes occurred. We report here on a case of a 35-year-old man with a 10×8×8 cm sized huge gastric bezoar that was successfully removed by combination therapy using an argon plasma and Coca-Cola injection. Compared with the previous single method, combination therapy using an argon plasma and Coca-Cola injection shortened the procedure time and reduced the complications related to a fragmented, remaining bezoar. (Korean J Gastrointest Endosc 2010; 40:370-373)

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A Bezoar That Caused Afferent Loop Syndrome and Pancreatitis: Hyuk Soon Choi, M.D., Chang Duck Kim, M.D., Hyun Seok Kang, M.D., Seok Bae Yoon, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Soon Ho Um, M.D. and Ho Sang Ryu, M.D.; Korean J Gastrointest Endosc 2009;39(5):291-295. Published online November 30, 2009

Abstract PDF: Bezoars are conglomerates of nondigestible matter in the gastrointestinal tract that may or may not be accompanied by gastrointestinal manifestations. Bezoars develop in patients with previous gastric surgery or in those patients with delayed gastric emptying that is due to gastroparesis caused by hypothyroidism or diabetes mellitus. Small bowel obstruction due to a gastric bezoar is rare, but it can lead to severe complications such as intestinal perforation, compression necrosis etc. A female patient came to our department complaining of upper abdominal pain and she was diagnosed as having a bezoar that was causing afferent loop syndrome and pancreatitis. We attempted to manage the patient by inserting a nasogastric tube, performing gastrofibroscopy and implementing percutaneous transhepatic biliary drainage, but the patient's condition worsened and deteriorated into a septic condition. An operation was planned, but the patient showed improvement owing to the migration of the bezoar. Herein, we report on a case of afferent loop syndrome due to bezoar and this was complicated by acute pancreatitis. (Korean J Gastrointest Endosc 2009;39:291-295)

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Esophageal Impaction of Trichobezoar Caused by Endoscopic Removal: Sang Hee Park, M.D., Jin Soo Moon, M.D.* and Tae Gil Huh, M.D.†; Korean J Gastrointest Endosc 2009;39(4):222-225. Published online October 30, 2009

Abstract PDF: Trichobezoar usually occurs in patients who have trichotillomania combined with trichophagia. Bezoars can result in serious complications including gastric ulceration, bleeding, perforation and small bowel obstruction when undiagnosed. The three main venues of bezoar removal (chemical dissolution, endoscopic removal and surgical removal) are chosen mainly by the size and composition of the bezoar. Trichobezoars generally require endoscopic or surgical removal. An 8-year-old girl visited our emergency room with recurrent epigastric pain and vomiting. Gastroduodenoscopy showed a 2×10 cm trichobezoar causing pyloric obstruction. During endoscopic removal of trichobezoar, esophageal impaction occurred. The trichobezoar was pushed into the stomach and was removed through surgical gastrostomy under general anesthesia. We report this case as an instructive reference for the proper treatment of trichobezoar in children. (Korean J Gastrointest Endosc 2009;39:222-225)

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A Case of Phytobezoar in the Common Bile Duct Following Percutaneous Transhepatic Papillary Large Balloon Dilatation: Byong Ryol Lim, M.D., Tae Hyo Kim, M.D., Min Ki Shin, M.D., Kang Ju, M.D., Chang Yoon Ha, M.D., Hyun Ju Min, M.D., Woon Tae Jung, M.D. and Ok Jae Lee, M.D.; Korean J Gastrointest Endosc 2009;39(3):181-184. Published online September 30, 2009

Abstract PDF: Biliary bezoar is a rare event that can cause cholangitis and pancreatitis. Biliary bezoar occurs infrequently by food material reflux and bile stasis following choledochoenterostomy, choledochoduodenal fistula, endoscopic sphincterotomy, duodenal diverticula, and because of suture remnants. We describe a phytobezoar in the common bile duct following percutaneous transhepatic large balloon papillary dilatation, which was successfully removed using an endoscopic procedure. (Korean J Gastrointest Endosc 2009;39:181-184)

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A Case of a Gastric Bezoar Combined with Superior Mesenteric Artery Syndrome: Min Kyoung Kang, M.D., Chang-Il Kwon, M.D., Ji Eun Lee, M.D., Yong Hun Kim, M.D., Kwang Hyun Ko, M.D., Sung Pyo Hong, M.D., Pil Won Park, M.D. and Hee Jin Kim, M.D.*; Korean J Gastrointest Endosc 2008;37(4):271-275. Published online October 30, 2008

Abstract PDF: Superior mesenteric artery syndrome is caused by compression of the third part of the duodenum between the superior mesenteric artery (SMA) and the aorta. Recently, we experienced a case of a gastric bezoar combined with SMA syndrome. A 58-year-old man presented with upper abdominal pain, bloating and weight loss of 5 kg. An endoscopic examination identified a huge gastric bezoar. The bezoar was broken and fragmented into small pieces using an argon plasma coagulator and endoscopic snare catheter. Hypotonic duodenography showed a longitudinal linear band that was presumed to be a vascular impression of the third portion of the duodenum and contrast-enhanced spiral CT showed a reduced distance of 8.4 mm but a normal angle of 38.5^o between the arota and the SMA. A second endoscopic examination demonstrated prominent pulsations that compressed the duodenal wall at the third portion. Luminal expansion with full inflation of air was not attempted under endoscopy. (Korean J Gastrointest Endosc 2008;37:271-275)

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Endoscopic Removal of Small Bowel Bezoars using Colonoscopy through the Oral Approach: Su Jung Baik, M.D., Ki-Nam Shim, M.D., Seong-Eun Kim, M.D., Hye-Kyung Jung, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Joo-Ho Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(4):276-279. Published online October 30, 2008

Abstract PDF: Bezoars are accumulations of foreign materials and foods in the gastrointestinal tract and can be the cause of small bowel obstruction. A bezoar usually begins as a gastric phytobezoar that migrates to the small bowel in patients who have undergone gastric surgery and have delayed gastric emptying. We report a case of diagnosed small bowel obstruction due to the presence of a persimmon phytobezoar (diospyrobezoar) in a patient with a history of gastric surgery. Abdomen-pelvis computed tomography demonstrated the presence of an air-containing localized lesion (5×3.5 cm), a suspicious bezoar in the jejunum. The gastroduodendoscopy failed to reach to the lesion but diospyrobezoars were found in the proximal jejunum at 120 cm from the upper incisors using a colonoscope inserted using the oral approach. Most of the bezoars were fragmented by a tripod and were removed with a snare. The patient was discharged after symptomatic improvement without surgery. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2008; 37:276-279)

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A Case of Small Intestinal Obstruction due to Bezoars Accompanied with Sump Syndrome: Joo Hee Kim, M.D., Kyo-Sang Yoo, M.D., Hyoung-Chul Park M.D.*, Tae Kyung Lim, M.D., Sun You Moon, M.D., Youn Son Chung, M.D., Su Mi Yoon, M.D., Kyoung Oh Kim, M.D., Yong Woo Chung, M.D., Cheol Hee Park, M.D., Taeho Hahn, M.D., Sang Hoon Park, M.D., Jong H; Korean J Gastrointest Endosc 2008;36(4):228-232. Published online April 30, 2008

Abstract PDF: Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome. (Korean J Gastrointest Endosc 2008;36:228-232)

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A Case of a Primary Esophageal Bezoar after a Total Gastrectomy: Hwa Mock Lee, M.D., Won Il Park, M.D., Hyun Ju Kim, M.D., Sung Han Yun, M.D., Nam Sik Kim, M.D., Seung Eun Lee, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Joon Seok Oh, M.D., Jong Yun Cheong, M.D., Won Ook Ko, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2008;36(2):71-73. Published online February 27, 2008

Abstract PDF: An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications. (Korean J Gastrointest Endosc 2008;36:71-73)

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A Case of Small Bowel Obstruction due to a Mushroom Bezoar: Song Yi Kim, M.D., Jae Woo Kim, M.D., Jin Hon Hong, M.D., Ki Won Jo, M.D., Hong Jun Park, M.D., Il Young Lee, M.D., Chang Jin Yea, M.D., Hyun Soo Kim, M.D.,Soon Koo Baik, M.D. and Mee Yon Cho, M.D.*; Korean J Gastrointest Endosc 2007;35(6):410-414. Published online December 30, 2007

Abstract PDF: A mushroom bezoar is an unusual type of bezoar and a rare cause of small bowel obstruction, with the only cases being previously described in the foreign literature. Common sites of obstruction are the gastric outlet, the terminal ileum as well as segments of pre-existing gastrointestinal stenosis of various etiologies. Predisposing factors include a high fiber intake, inadequate chewing, gastric hyposecretion and hypomotility, and a previous gastrectomy and vagotomy. Computed tomography has the capability of directly showing the bezoar and displaying the resulting small bowel obstruction. We report a case of incomplete small bowel obstruction in a 38-year-old woman, caused by a mushroom bezoar in the terminal ileum. (Korean J Gastrointest Endosc 2007;35:410-414)

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A Case of Aggravated Esophageal Candidiasis and Gastric Yeast Bezoar Formation following Gastric Outlet Obstruction due to Duodenal Stenosis: Jung Hoon Song, M.D., Eun Bin Lee, M.D., Nam Seon Park, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D., Kyu Chel Lee, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(4):205-209. Published online April 30, 2007

Abstract PDF: Esophageal candidiasis is the most common disease among all candida infections of the gastrointestinal tract, and generally develops in immunocompromised patients. The prevalence of esophageal candidiasis has increased in patients undergoing antibiotic therapy, diabetes, adrenal dysfunction, alcohol intoxication, old age, esophageal injury, esophageal stasis, gastric surgery, and acid suppressive therapy. However, the overall prevalence is not higher than that of immunocompromised patients. Gastric candidiasis is uncommon because of the strong acidity of the gastric juices. The most common clinical setting for gastric candidiasis is in patients with neoplastic disease. However, there are some case reports suggesting an increase in the prevalence of gastric candidiasis after gastric ulcer therapy with surgery or acid suppressive agents. Delayed gastric emptying, increased intragastric pH, and reflux of the duodenal contents into the stomach are factors indicative of the pathophysiology of gastric candidiasis after gastric surgery. We encountered a case of aggravated esophageal candidiasis and the formation of a gastric yeast bezoar following a gastric outlet obstruction due to a duodenal stenosis. We herein report this case along with an overview of the relevant literature. (Korean J Gastrointest Endosc 2007;34:205⁣209)

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A Case of Huge Gastric Phytobezoar Removed by Endoscope using Argon Plasma: Byung Wook Ha, M.D., Ji Hoon Kim, M.D., Young Tak Seo, M.D., Mi Jin Kim, M.D., Young Hwan Ham, M.D., Sang Su Bae, M.D. and Hyung Jun Chu, M.D.; Korean J Gastrointest Endosc 2007;34(2):88-93. Published online March 2, 2007

Abstract PDF: Bezoars are persistent concretions of indigestible material that are usually found in the stomach. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic forceps, snares, electrohydraulic lithotripsy, laser. However, there are no reports of using argon plasma to remove a bezoar in Korea. Argon plasma coagulation is a non-contact electrosurgical technique, which is an inexpensive, easily learned, and effective method in gastrointestinal endoscopy. In addition, this method is associated with a decreased risk of perforation and tissue damage by maintaining a controllable depth of coagulation. We report a 71-year-old man with a 11×11×8 cm sized huge gastric phytobezoar found by endoscopy. The bezoar was broken into pieces using the argon plasma coagulator. Endoscopic forceps and a basket were then used to crush and extract its fragments. The bezoar was removed safely without any complications. We report this case with a review of the relevant literature.

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A Case of Gastric Bezoar Treated by an Endoscopic Coca-Cola Injection: Sue Jin Kim, M.D., Jun Haeng Lee, M.D., Woo Ik Chang, M.D., Kyoung A Choi, M.D., A-Reum Han, M.D., Young Bong Song, M.D. Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2007;34(1):38-42. Published online January 30, 2007

Abstract PDF: Bezoars are the most common foreign bodies in the stomach as seen endoscopically with a frequency of approximately 0.4%. They consist of persistent concretions or hard accumulations of non-digestible vegetable matter, hair or more unusual materials. Gastric bezoars develop in patients with previous gastric surgery, gastric outlet obstruction, or poor gastric emptying such as gastroparesis due to hypothyroidism, diabetes mellitus or mixed connective tissue disease. The clinical presentations of gastric bezoars include epigastric pain, a palpable mass, a gastrointestinal obstruction and peptic ulceration. The treatment options include surgery, enzymatic dissolution or endoscopic mechanical fragmentation and/or removal. Recently, the efficacy of the administration or lavage of 'Coca-Cola' for the effective dissolution of gastric bezoars has been reported. We report a case of a 27-year-old woman with a large gastric bezoar that was successfully removed by the direct endoscopic injection of a carbonated beverage ('Coca-Cola light', a sugar free product; Coca cola Co., Seoul, South Korea) into the bezoar, which led to fragmentation.

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A Case of Small Bowel Obstruction due to Multiple Trichobezoars: Sang Won Park, M.D., Yun Sok Yang, M.D., Ho Sup Lee, M.D., Jyung Hyun Kim, M.D., Chang Goo Lee, M.D. and Jin Kwan Lee, M.D.; Korean J Gastrointest Endosc 2005;31(6):423-426. Published online December 30, 2005

Abstract PDF: Trichobezoars are gastric concretions that are composed of hair or fibers. They are more common in children and adolescents and are usually associated with a pica, emotional disturbance, or mental retardation. Trichobezoar is quite rare in Korea. In most cases, trichobezoars tend to form a cast of the stomach. However, in rare cases, portions of the trichobezoar may separate from the gastric mass, migrate distally, and obstruct the small bowel. We report a case of small bowel obstruction due to multiple trichobezoars in a 14 year-old-girl who had a habit of swallowing hairs until 12 years of age. The patient was treated successfully surgically. (Korean J Gastrointest Endosc 2005;31:423⁣426)

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A Case of Gastric Bezoar Formed by Ingestion of Gypsum, and it was Treated Endoscopically Using Electrohydraulic Lithotripsy: Jong Kwan Park, M.D., Min Su Kim, M.D., Young Gyun Kim, M.D., Won Na Suh, M.D., Tae Il Kim, M.D. and Hyojin Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):328-333. Published online November 30, 2005

Abstract PDF: Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy. (Korean J Gastrointest Endosc 2005;31:328⁣333)

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A Case of Primary Esophageal Bezoar: Ji Hyang Yoon, M.D., Ok Jae Lee, M.D., Eun Jung Lee, M.D., Hong Jun Kim, M.D., Hyung Jun Kim, M.D., Hyun Jin Kim, M.D., Tae Hyo Kim, M.D. and Woon Tae Jung, M.D.; Korean J Gastrointest Endosc 2003;27(3):143-147. Published online September 30, 2003

Abstract PDF: Bezoar is a persistent concretion of indigestible materials, usually found in the stomach, and most cases have been managed by surgical methods. Esophageal bezoars are very rare and have been mainly reported in patients with esophageal motility or anatomical abnormalities. We experienced a case of primary esophageal bezoar dissolved with pancreatic enzyme extracts. A 79-year-old man complained of dysphagia of a 15-day duration. Esophagoscopy revealed a large, yellow-brownish, round, hard mass obstructing the esophageal lumen and a deep ulcer, 30 cm from the incisor teeth. Multiple attempts to break or retrieve it were tried, but failed. He accepted surgical treatment and took a pancreatic enzyme preparation during preoperative evaluation of his heart problem. After 20 days, his symptom was relieved, and bezoar disappeared completely on a follow-up endoscopy. Esophageal manometry disclosed nonspecific esophageal motility disorder.

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83세 남자, 전복부 통증: Korean J Gastrointest Endosc 2003;26(5):384-384. Published online May 30, 2003

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위석 ( Bezoar ) 이 원인으로 추정되는 Gastritis Cystica Profunda 1 예: Korean J Gastrointest Endosc 2001;23(5):375-375. Published online November 30, 2000

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구연 / 포스터 : Small Bowel Bezoar Complicated with Intestinal Obstruction: Korean J Gastrointest Endosc 2001;22(5):361-361. Published online November 30, 2000

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증례 / 소장폐색을 일으킨 Phytobezoar 2예 ( Small Intestinal Obstruction due to Phytobezoars - Case reports - ): Korean J Gastrointest Endosc 2001;22(3):182-186. Published online November 30, 2000

Abstract PDF: Phytobezoars are the most common type of bezoars composed of nondigestible food material. They are usually formed in stomach and do not migrate to the other intestinal tract. Recently, we experienced two cases of small bowel phytobezoars resulting in obstruction. The first case is a 72-year-old male patient who had no previous history of surgery. He had poor dentition, and the history of eating dry persimmons 20 days before the onset of symptoms. The phytobezoar (4x3cm) obstructed the terminal ileum. Colonoscopic removal was performed successfully. The second case is a 45-year-old male patient undergone previous vagotomy and pyloroplasty for duodenal ulcer perforation. He had a huge phytobezoar (10 X 6 cm) in stornach, which was treated by endoscopic removal. After incomplete endoscopic treatment, it moved into the proximal jejunum and obstructed the lumen. It was removed by operation, (Korean J Gastrointest Endosc 2001;22:182 - 186)

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위에서 식도로 역류한 위석 1예 ( A Case of a Gastric Bezoar Regurgitated from the Stomach to the Esophagus ): Korean J Gastrointest Endosc 1999;19(6):930-934. Published online November 30, 1998

Abstract PDF: Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket. (Korean J Gastrointest Endosc 19: 930∼934, 1999)

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증례 : 식도 위장관 ; 정상 십이지장 구부에서 발견된 Bezoar 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of a Bezoar Found in a Normal Duodenal Bulb ): Korean J Gastrointest Endosc 1998;18(3):399-402. Published online November 30, 1997

Abstract PDF: A 50-year-old man who had suffered from chronic indigestion complained of upper abdominal pain and vomiting which had persisted for 4 days. Consequently, he had eaten two persimmons before sleeping detected each day for five days. An irregular multinodular villous filling defect was in the duodenal bulb on, the UGI series, which had its location and changed its position. It was difficult to differentiate a papillary gastric polyp or villous tumor from the duodenal bezoar, but the patient's history of having eaten persimmons was helpful. The endoscopic and pathologic study confirmed a phytobezoar which was located in the normal duodenal bulb. Subsequently we are reporting this case having reviewed the related literature of the phytobezoar which was found in the normal duodenal bulb. (Korean J Gastrointest Endosc 18: 399-402, 1998)

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증례 : 식도 위장관 ; 위석이 합병된 당뇨병성 위마비 치험 1예 - 증례 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Diabetic Gastroparesis Complicated with a Gastric Bezoar ): Korean J Gastrointest Endosc 1998;18(3):381-386. Published online November 30, 1997

Abstract PDF: Diabetic gastroparesis is a common gastrointestinal complication which develops in about 20-30% of patients with longstanding diabetes mellitus. Recent studies have shown that erythromycin stimulates gastrointestinal motor activity by binding on motilin receptors of gastrointestinal smooth muscles and that it improves gastric emptying in patients with diabetic gastroparesis. In this respect, we present a 35-year-old patient with diabetic gastroparesis, complicated with a gastric bezoar, who was successfully treated with endoscopic bezoar fragmentation and oral erythromycin for 3 weeks. (Korean J Gastrointest Endosc 18: 381-386, 1998)

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증례 : 식도 위장관 ; 위내시경용 용종 제거술 올가미와 담석 쇄석기를 사용해 분쇄 제거한 위석 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of Gastric Bezoar Removed by Endoscopic Polypectomy Snare and Lithotriptor ): Korean J Gastrointest Endosc 1998;18(3):373-379. Published online November 30, 1997

Abstract PDF: Gastric bezoar has been known to occur occasionally in the gastrointestinal tract, as a result of foreign material accumulating in the stomach. Most case have been managed by surgical methods. Currently, the endoscopic mathod is after used for the gastrointestinal disease, and therefore we treated two cases of huge bezoars using the endoscopic polypectomy snare and lithotriptor. Subsequently, we are reporting these cases and have incorporated relevant literature which was reviewed for our report for the subject case. (Korean J Gastrointest Endosc 18: 373-377, 1998)

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증례 : 식도 위장관 ; 소장 폐색을 보였던 위석 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Small Intestinal Obstruction Due to a Fragment of Gastric Phytobezoar ): Korean J Gastrointest Endosc 1996;16(4):658-665. Published online November 30, 1995

Abstract PDF: Phytobezoar is rare disease in the stomach and small bowel of the patient without underlying previous gastroenterologic pathology. Because it usually occurs secondarily to peptic ulcer surgery, poor mastication, diabetes mellitus, hypothyroidism and connetive tissue disease. In morden medicine, phytobezoars found in the stomach and/or intestines in humans, are known to be associated with considerable morbidity and even mortality. Patients with gastric bezoar present with chronic postprandial epigastic pain, nausea, and vomitihg. It is diagnosed by endoscopic examination or radiologic study and treated by surgical removal or non-surgical methods including conservative treatment, enzymatic dissolution, and endoscopic removal. We have experienced a case of small intestinal obstruction due to a fragment of gastric bezoar of the patient without underlying etiologic cause. So we report the case with a brief review of literatures. (Korean J Gastrointest Endosc 16: 658-668, 1996)

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