Novel approach to managing two enormous bezoars with successive snare-tip electrocautery: A case report.

Abstract

Background: Gastric bezoars are indigestible masses that can lead to gastrointestinal obstruction and ulceration. Standard treatments include endoscopic mechanical lithotripsy with a polypectomy snare and Coca-Cola dissolution therapy or a combination of both approaches. However, giant bezoars frequently require multiple treatment sessions and extended hospital stays. Additionally, snare-based mechanical fragmentation may be limited by factors such as bezoar size, shape, density, slipperiness, and restricted working space. In cases where refractory giant bezoars are unresponsive to traditional methods, surgical intervention is often necessary.

Case summary: A 57-year-old male with a history of type 2 diabetes presented with severe epigastric pain and vomiting. Endoscopy revealed two large phytobezoars and a gastric ulcer. Initial attempts at mechanical fragmentation with a polypectomy snare and Coca-Cola ingestion for dissolution were unsuccessful due to the large size and complex structure of the bezoars. An innovative approach using snare-tip electrocautery was then employed. It successfully penetrated the slippery, hard surface of the bezoars and fragmented them into smaller pieces. The patient was subsequently treated with Coca-Cola ingestion, enzyme supplements, and proton pump inhibitors. He was discharged without complications following the endoscopic sessions.

Conclusion: Snare-tip electrocautery is a safe, cost-effective, and minimally invasive alternative for managing large, refractory gastric bezoars. This is a valuable option in resource-limited settings.