Postgastrectomy phytobezoars--endoscopic diagnosis and treatment

Thirty-three consecutive patients with 38 bezoars were identified since 1975. Twenty-nine patients (87.8%) had undergone previous gastric surgery. The average interval between surgery and bezoar diagnosis was 7.7 years. There were 14 men and 19 women (mean age, 61.5 years). Epigastric distress (84%) and weight loss (31%) were the most common complaints. Twenty-two (75.9%) of 29 barium studies were falsely negative. Attempts at prior enzymatic dissolution had failed in three patients. Three (13.6%) of 22 patients available for follow-up had multiple episodes of bezoar formation. All patients underwent esophagogastroduodenoscopy for diagnosis and concomitant fragmentation and "flushing" of the bezoar for resolution. The success rate was 100%; no complications occurred.