New therapeutic approach in postoperative phytobezoars

Area of Science:

• Gastroenterology
• Surgical Outcomes

Background:

• Postoperative phytobezoars can form after duodenal ulcer surgery, often linked to delayed gastric emptying.
• The long-term implications and effective management of these bezoars require further investigation.

Purpose of the Study:

• To evaluate the efficacy of a conservative treatment strategy for postoperative phytobezoars.
• To investigate the role of delayed gastric emptying in phytobezoar formation and resolution.

Main Methods:

• A conservative approach was employed, focusing on managing delayed gastric emptying.
• Treatment involved a 3-day course of intravenous metoclopramide (40 mg/24 hours) and a clear liquid diet.
• Radiological (x-ray) and endoscopic (gastroscopy) examinations were used for diagnosis and monitoring.

Main Results:

• Seven patients with postoperative phytobezoars achieved complete resolution through conservative management.
• One patient required two treatment courses for complete phytobezoar elimination.
• Endoscopic examination revealed underlying etiological factors in some cases, including stomal carcinoma and retained sutures.

Conclusions:

• Conservative management, targeting delayed gastric emptying, is effective in resolving postoperative phytobezoars.
• Delayed gastric emptying is a significant factor in the formation of these bezoars.
• Endoscopy is crucial for identifying potential underlying causes of phytobezoar formation.