Treatment of Gastric Bezoar using Direct Injection of

Treatment of Gastric Bezoar using Direct Injection of ‘Coca-Cola light’ Young Bong Song, Jun Haeng Lee, Jae J. Kim, Jong Chul Rhee Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul Korea

Bezoar에 의한 small bowel obstruction

위석 제거를 위해 입원시 소견 • CBC : 6510 -13. 1 - 468 k • AST/ALT : 14/8 U/L • BUN/Cr : 15. 2/0. 63 mg/d. L • Na-K-Cl : 142– 4. 0– 105 • FBS 108 mg/d. L • Total cholesterol 192 mg/d. L • HBs Ag/Ab (-/+), Anti-HCV(-) Operation scar

Lithotripsy basket을 이용한 1차 시도

Bezoar removal with Coca Cola light

Bezoar immersed in Coca Cola light

Bezoar immersed in Coca Cola light overnight

Follow up EGD with EUS(2. 21)

Gastric emptying time

Gastric Bezoar • Definition: persistent concretions found in the stomach, plant and vegetable fibers(phytobezoars), persimmons(disopyrobezoars), or hair(trichobezoars) • Epidemiology: 0. 4% (the reported incidence) –uncommon 10 -25%-in postgastrectomy population, especially • Etiology and Pathogenesis: Large particulate size, inadequate mastication, indigestibility(low gastric acidity , etc), gastric outlet obstruction, poor gastric emptying(vagotomy and pyloroplasty, antrectomy, partial gastrectomy, DM) • Clinical Presentation: usually asymptomatic most frequent symptom- epigastric pain(70%) early satiety, upper abdominal fullness, N/V, intestinal obstruction, halitosis, peptic ulcerations(phyto->>tricho-) • Diagnosis: EGD- the best diagnostic and non-surgical therapeutic procedure Upper gastrointestinal barium series

• Classification of Bezoars - Phytobezoar or plant bezoar : the most common form - Disopyrobezoar(persimmons) - Trichobezoar(hair) - Rectal bezoar(Popcorn, Sunflower seeds) • Treatment - Surgical treatment - Non-surgical treatment : Endoscopic therapy(Snare/basket/forcep/Nd: YAG laser) Enzymatic therapy (Papase/cellulase/Chymopapain/Acetylcystein) Miscellaneous therapy (lavage/suction, prokinetics, liquid diet) - “Coca-Cola” or “Coca-Cola light” injection : possible mechanisms - p. H 2. 6( a substitute for normal gastric acidity) - fluid volume and the release of carbon dioxide ‘Intrabezoar injection’: rapidly effective, inexpensive, and safe