Lim CH, Lim CJ, Yao CT, Chang CC. Novel approach to managing two enormous bezoars with successive snare-tip electrocautery: A case report. World J Gastrointest Endosc 2025; 17(1): 102185 [DOI: 10.4253/wjge.v17.i1.102185]
Corresponding Author of This Article
Cherng Harng Lim, MD, Chief Physician, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lukang Christian Hospital, No. 480 JhonJheng Rd, Lugang Township, Changhua 505002, Taiwan. zacklim412059@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Cherng Harng Lim, Chih-Ta Yao, Chi-Chun Chang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lukang Christian Hospital, Changhua 505002, Taiwan
Cherng Jyr Lim, Department of Emergency Medicine, Hsinchu Cathay General Hospital, Hsinchu 300029, Taiwan
Co-first authors: Cherng Harng Lim and Cherng Jyr Lim.
Author contributions: Lim CH contributed to the medical care and treatment planning; Lim CJ wrote the manuscript and collected the data; Yao CT and Chang CC performed the research and provided critical suggestion. All authors reviewed and approved the final version of the manuscript. The equal contributions of Lim CH and Lim CJ were critical for the generation and production of this case report, and their collective efforts merit the co-first authorship designation.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images (approval certificate No. CCH IRB 240624).
Conflict-of-interest statement: The authors state that there is no conflict of interest to be declared.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cherng Harng Lim, MD, Chief Physician, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lukang Christian Hospital, No. 480 JhonJheng Rd, Lugang Township, Changhua 505002, Taiwan. zacklim412059@gmail.com
Received: October 12, 2024 Revised: November 27, 2024 Accepted: December 16, 2024 Published online: January 16, 2025 Processing time: 97 Days and 2.9 Hours
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.
Core Tip: Snare-tip electrocautery provided precise and efficient fragmentation of refractory bezoars, which reduced the need for surgery. Snare-tip electrocautery may be particularly useful in cases unresponsive to conventional treatments.
