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DOI: 10.1055/a-2008-8134
Endoscopic laser lithotripsy for a giant duodenal bezoar: the first clinical experience
A bezoar causing complete duodenal obstruction is uncommon; surgical operation is the usual treatment choice when it does occur. Here, we report our experience of using endoscopic laser lithotripsy for a giant duodenal bezoar.
A 58-year-old man complained of upper abdominal pain and intermittent vomiting for 1 week. He had history of eaten persimmons. An abdominal computed tomography scan showed a 5.0 × 2.5 × 2.5-cm bezoar in the third part of duodenum ([Fig. 1]). Following multidisciplinary discussion, we decided to perform endoscopic therapy. Gastroscopy showed a giant bezoar completely obstructing the lumen of the duodenum. We tried to break the bezoar with foreign body forceps, and snare and basket, but failed owing to its huge size and hard nature ([Fig. 2 a]). Next, we tried treating the bezoar using laser lithotripsy (U100plus; W.O.M., Germany), with an application energy of 120 mJ and a pulse repetition rate of 6 Hz chosen for the attempts. Multiple holes were drilled on the bezoar to break it up ([Fig. 2 b]). Finally, the bezoar was successfully broken into small pieces and the bezoar fragments were removed with a forceps ([Video 1]). Breakage of the bezoar and removal of the fragments resulted in the reopening of the lumen of the duodenum ([Fig. 2 c]). The whole procedure took about 95 minutes and the patient recovered uneventfully.
Video 1 A giant duodenal bezoar that could not be removed with a basket is treated with endoscopic laser lithotripsy to break it up and allow removal of the fragments with a forceps.
Quality:
The U100plus laser was designed originally to break up common bile duct stones. This is the first time that we have used it to break up a giant duodenal bezoar and we show that it is an effective method.
Endoscopy_UCTN_Code_TTT_1AO_2AL
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Competing interests
The authors declare that they have no conflict of interest.
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Publication History
Article published online:
09 March 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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