METHODS: A 76-year-old man was referred to our outpatient endoscopy clinic because of dyspepsia and epigastric pain. Upper GI endoscopy with a standard endoscope revealed a 10-cm-diameter gastric phytobezoar with necrotic pressure ulcer of the angulus. We fragmentized the bezoar into smaller pieces, with complete dissolution and without any complication. The patient was then promptly discharged home with a medical therapy. Follow-up endoscopy at 6 months showed the total disappearance of any residual fibers.
CONCLUSIONS: Different types of bezoars are described in literature, of which phyto- and trychobezoars are the most frequent. They can be absolutely asymptomatic or can arise with epigastric pain, pressure ulcer bleeding, gastrointestinal perforation or small bowel obstruction. The treatment is debated though endoscopic removal or fragmentation with the help of Coca-Cola lavages has showed the best success rate. The main experiences in literature concern hospitalized patients or describe treatment techniques which require overnight stays. An effective and rapid treatment in the outpatient setting is described in our experience, without short- or long-term complications.
CONCLUSIONS: The endoscopic fragmentation of large gastric bezoars in the outpatient setting is safe with a good clinical course.
方法:一名76岁的男子因消化不良和上腹痛被转诊到我们的门诊内镜诊所。使用标准内窥镜进行的上消化道内窥镜检查显示,直径为10厘米的胃植物牛,并伴有坏死性压迫性溃疡。我们把牛黄分成更小的碎片,完全溶解,没有任何并发症。然后,患者通过药物治疗迅速出院。6个月时的随访内窥镜检查显示任何残留纤维完全消失。
结论:文献中描述了不同类型的牛黄,其中植物性和trychobezoars是最常见的。它们可以是绝对无症状的,或者可以出现上腹痛,压疮出血,胃肠道穿孔或小肠梗阻。尽管在可口可乐灌洗的帮助下进行内窥镜清除或碎裂显示出最好的成功率,但仍在争论治疗方法。文献中的主要经验涉及住院患者或描述需要过夜的治疗技术。在我们的经验中描述了在门诊环境中有效和快速的治疗方法,无短期或长期并发症。
结论:在门诊环境下内镜下破碎大胃结石是安全的,临床过程良好。