Review of the diagnosis and management of gastrointestinal bezoars

Figure 1 Endoscopic images of a persimmon phytobezoar. A: A large, black bezoar is seen in the gastric fundus; B: A peptic ulcer is also observed in the gastric angle; C: Fragmentation of the bezoar was performed by endoscopy forceps and polypectomy snares; D: The fragments were removed by a retrieval net device and used in the subsequent in vitro analysis.

Figure 2 Photographs of the in vitro experiment. A: Endoscopically extracted fragments of the gastric bezoar were used; B: Representative photographs of the bezoar fragments incubated at 37 °C with gentle swirling for 12 h with double-distilled water; C: Bezoar fragments after incubation with Coca-Cola^®; D: Bezoar fragments after incubation with Coca-Cola Zero^®; E: Bezoar fragments after incubation with a digestive enzymes supplement including cellulase; F: Bezoar fragments after incubation with papain. The bezoar fragments were clearly more softened and more fragmented after 12-h incubation with Coca-Cola^® or Coca-Cola Zero^® than with the other agents.

Figure 3 The dissolubility of bezoar fragments. The mean dissolubility of bezoar fragments was highest by Coca-Cola^®, but the difference between Coca-Cola^® and water was not significant (P = 0.06) due to the relatively large standard deviation. NS: Not significant. ^aP < 0.05.