A new technique for endoscopic treatment of gastric phytobezoars : fragmentation using guidewire

Background and Study Aims : Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often oc- cur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. Patients and Methods : Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endo- scope. PBs were surrounded by a loop in the guidewire and de- stroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. Results : PB fragmentation time was 5-11 minutes. In five pa- tients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients addi- tionally treated with enzymatic degradation after the breaking pro- cedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. Conclusions : The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzy- matic degradation, PBs can be managed quickly and effectively. (Acta gastroenterol. belg., 2014, 77, 389-392).