Gastric Bezoar

Abstract

Objectives: To determine the demographics, potential risk factors, endoscopic interventions and outcomes relating to gastric bezoars in pediatric patients; and comparing results with previously published literature. Methods: Retrospective series by chart review of patients identified by International Classification of Diseases-9 codes 938 and 935, using the following Medical Subject Headings: 1, term bezoar; 2, Keywords gastric bezoar∗ or gastric foreign body∗. Results: Thirty pediatric patients between ages of 2 to 18 years were found with gastric bezoars, with a female predominance. Majority had a phytobezoar. Six patients were diagnosed with dysautonomia, implying possible role of autonomic dysfunction contributing to abnormal gastric retention. Frequent symptoms included abdominal pain, nausea and vomiting, a decrease in appetite, and unintentional weight loss. A higher prevalence of underlying gastrointestinal disorders was found in those with bezoars. Nuclear medicine gastric emptying scan performed in 13 children was significantly abnormal in only 4 of these children. Most patients were treated with endoscopic removal of the bezoar. Endoscopic removal was accomplished by Roth net, generally requiring multiple passes. At follow-up, most of the children had improvement of symptoms, with bezoar recurrence in 1 patient. Conclusions: This is to our knowledge the largest series of gastric bezoars in pediatrics. On the basis of our review, phytobezoars may be under-reported in pediatrics. Bezoars should be considered in children presenting with chronic abdominal pain, nausea, and vomiting; even in developmentally normal children and those with normal gastric emptying. We suggest that dysautonomia and underlying gastrointestinal disorders may be potential risk factors.

Self-made wire loop snare successfully treats gastric persimmon stone under endoscopy

“…Patients with subtotal gastrectomy, vagus nerve amputation, or gastroparesis syndrome are prone to gastrolithiasis, which may be associated with factors like low gastric acid, gastric emptying disorder, and pyloric dysfunction that lead to conditions in which undigested food remains in the stomach for a long time[ 1 ]. In our study, 21.0% (8/38) of the patients had diabetes and 10.5% (4/38) had a history of gastric surgery, indicating that the formation of gastroliths was associated with physiological disorders of the stomach.…”

“…Gastrolithiasis is a condition caused by ingestion of plants, hair, or minerals, such as calcium carbonate, barium, and bismuth that cannot be digested[ 1 ] and condense to form foreign bodies, or bezoars, commonly in the stomach[ 2 ]. The incidence of gastroliths is low, with an endoscopic detection rate of approximately 0.31%[ 3 ].…”

“…Foreign body forceps that can be easily used to remove gastric persimmon stones have recently been introduced, but the equipment is expensive and most medical institutions have not purchased them. Hence, their use is currently limited[ 1 ].…”

Therapeutic Upper Gastrointestinal Endoscopy in Pediatric Gastroenterology

“…The overall incidence of bezoars in children is unknown, and to date, only few studies exist, most of them case reports or case series. There are several types of bezoars with phytobezoars (composed of plant and vegetable components) being the commonest type (27). In comparison, trichobezoars are composed of hair, undigested fat, and mucus.…”

“…The current management of gastric bezoars include dissolution (either by Coca-Cola beverages, cellulose, or papain), endoscopy, or surgery (laparoscopic and open) (27). With the help of an endoscope, the bezoar can be separated into smaller pieces using a polypectomy snare, biopsy forceps, directed water jets, injection of enzymes (papain and cellulose for phytobezoars), or mechanical lithotripsy (bazotome, a needle knife device, or bezotriptor, a lithotriptor), a device commonly used for the treatment of large bile duct stones (Figure 5D) (27,30). Once the bezoar is broken into smaller pieces, these can then be either removed endoscopically or allowed to pass through the pylorus.…”