Authors (including presenting author) :
SO Y
Affiliation :
(1) The department of Surgery, Tuen Mun Hospital
Keyword 1: :
Bezoar removal
Keyword 2: :
Endoscopic technique
Keyword 3: :
Balloon inflation
Keyword 4: :
Upper gastrointestinal
Keyword 5: :
endoscopic removal of bezoars
Introduction :
Bezoars are agglutinations of ingested materials to form insoluble mass in gastrointestinal tract, most common in stomach. There are different types of bezoars including phytobezoars, trichobezoars andpharmacobezoars. Risk factors of bezoar formation causing obstruction are prior gastric surgery, altered gastric motility, medications etc. Phytobezoars usually can be dissolved by chemicals such as soft drinks. However, diospyrobezoars and trichobezoars are resistant to chemical dissolution and require endoscopic or surgical removal. Some hard or giant bezoars needs to be fragmented first by using various endoscopic devices such as biopsy forceps, alligator forceps, a polypectomy snare etc and then be retrieved by using endoscopic basket or net. Migration and reassembly of fragment can cause intestinal obstruction and requires repeated endoscopic removal. Surgical removal is usually indicated for cases failed to remove bezoar by using chemicals or endoscopic therapies.
Objectives :
The objective of this case report is to present a clinical case of a gastric bezoar obstructing the small bowel in a patient with a history of gastrectomy and gastrojejunal stricture, and to demonstrate the safety and efficacy of endoscopic removal using a novel technique of distal balloon inflation to prevent fragment migration and reassembly.
Methodology :
Single patient case report was selected to demonstrate the distal balloon inflation technique for endoscopic removal.
Result & Outcome :
A 69-year-old male with a surgical history of repeated gastrectomy for stomach cancer and post-operative gastrojejunal stricture presented with epigastric pain and vomiting. Small bowel follow through revealed proximal small bowel stenosis due to a bezoar. Esophagogastroduodenoscopy identified a large bezoar 15cm from gastrojejunostomy site. The distal ballon inflation (DBI) method was deployed: a balloon was inflated distal to the bezoar, followed by fragmentation and retrieval of all pieces. The patient recovered uneventfully and remained asymptomatic at follow-up 2 months later. The distal balloon inflation technique helps to prevent small fragments passing distally or reassembly of residual fragments and causing intestinal obstruction, especially in cases with history of gastrectomy that might have known stenosis. All fragments were removed with net in this case report. No surgical removal was required. This technique is recommended for similar high-risk cases.
