Endoscopic removal of gastric phytobezoars

We encountered 11 patients with 13 gastric phytobezoars over a 15-month period. Barium contrast studies failed to detect the bezoar in 55% (6/11), whereas all concretions were evident during endoscopy. Gastric, duodenal, or marginal ulcers were noted at endoscopy in 45% (5/11), but none were detected on radiography. Various forms of medical therapy were unsuccessful in eliminating the bezoars. Two patients were treated surgically and two were lost to follow-up. Nine bezoars in the remaining seven patients were removed completely by suctioning the fragmented concretion through a large channel endoscope (Olympus GIF-1T or TCF-1S) in well-tolerated treatment sessions lasting an average of 50-60 minutes. No complications or failures were encountered, but symptoms were not usually eliminated after evacuation of the bezoar. Endoscopic removal of bezoars offers an attractive alternative to surgery or other forms of medical therapy.