[Endoscopic fragmentation of gastric phytobezoars as a valid alternative, in selected cases, to traditional surgery]

Three cases of gastrointestinal bezoar are described. Two were submitted to conventional surgery and one to endoscopic fragmentation. The natural and postoperative pathophysiologic mechanisms responsible for the formation of bezoars were studied. The condition is generally asymptomatic, the clinical presentation being similar to that of gastritis and/or duodenitis. Endoscopy is the non-invasive technique of choice in the diagnosis of gastric bezoars. Treatment of these lesions in day-endoscopy consists in removal of the bezoar if less than 3 cm in diameter and fragmentation if larger in diameter followed by extraction of any fragments over 1 cm to prevent the risk of intestinal obstruction. Long term maintenance therapy with cisapride or metoclopramide is then immediately administered for preventive purposes, and it is also used in patients submitted to traditional gastric and/or duodenal surgery.