Journal Information
Vol. 87. Issue 3.
Pages 394-396 (July - September 2022)
Vol. 87. Issue 3.
Pages 394-396 (July - September 2022)
Scientific letter
Open Access
Esophageal bezoar: A multidisciplinary approach
Bezoar esofágico: un abordaje multidisciplinario
M. Muñiz-Muñoz
Corresponding author

Corresponding author at: Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Avenida Juan Carlos I, s/n, Ávila 05004, Spain. Tel.: +34651340554.
, P. Segovia-Alonso, M.P. Delgado-Álvarez, R. Villanueva-Hernández
Servicio de Aparato Digestivo, Hospital Nuestra Señora de Sonsoles, Complejo Asistencial de Ávila, Ávila, Spain
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Esophageal bezoar is a rare condition that is usually associated with structural or motility disorders1. Endoscopy is the main tool for diagnosis and treatment, requiring a single session or multiple sessions1,2.

An 81-year-old man was admitted in the emergency department with dysphagia and hypersalivation after having eaten bread and fish three days prior. He had a history of diabetes mellitus, ischemic stroke, ischemic heart disease, and was in treatment with acetylsalicylic acid, metformin, pantoprazole, indapamide, and perindopril. The patient had presented with progressive dysphagia to solid food for the past few months but had not sought medical attention. Physical examination, chest X-ray, and blood test were normal.

An esophageal endoscopy was performed. The esophagus was completely obstructed by a firm, yellowish concretion, 25cm from the incisor teeth (Figs. 1 and 2). Multiple endoscopic maneuvers were employed (polypectomy snare, Roth net, and forceps), but all were unsuccessful.

Figure 1.

Endoscopic view of the proximal esophagus with food remnants that allowed passage of the endoscope.

Figure 2.

Endoscopic view of the yellowish bezoar causing complete esophageal obstruction.


We proceeded to inject a carbonated soft drink (cola) into the bezoar to soften it, using the tip of a 22-Fr injector through the accessory channel of the endoscope. A tunnel, 25–40cm from the incisor teeth, was constructed with alligator forceps, but the remaining bezoar prevented the stomach from being reached. The cola reflux had to occasionally be sucked up from the oropharynx through a tube, to avoid the risk of bronchial aspiration. Taking into account the risk of an iatrogenic event resulting from a long procedure, we decided to finish the endoscopic session and start treatment with prokinetics.

One day later, the patient was asymptomatic, so we attempted to dissolve the remaining bezoar with oral cola intake (250−1000ml per day). Three days after the endoscopy, computerized tomography was normal.

We decided to repeat the endoscopy four days after the patient was admitted to the hospital. The esophagus had reduced peristalsis, with tertiary waves, the esophagogastric junction was permanently puckered, and no mucous alterations were found.

With high suspicion of an esophageal motility disorder, we ordered a manometry at a tertiary care center, and discharged the patient, with a crushed food diet. We asked the cardiologist if the antihypertensive treatment could be changed to a calcium antagonist, given the high suspicion of achalasia. Three months later, the patient was asymptomatic. He has since moved to another city and is continuing follow-up there.

Esophageal bezoar is a rare condition. When the initial attempts at endoscopic removal are not successful, a combined treatment should be considered. There have been reports of intra-esophageal instillation of pancreatic enzymes3 or a cola-type carbonated soft drink, through a nasogastric tube, as treatment1. In the present case, mimicking the management of a gastric bezoar, we successfully used oral lavage with cola and endoscopic direct intra-bezoar infusion4. The mechanism through which the cola dissolved the bezoar could be: mucolysis by NaHCO3, acidification by carbonic acid and phosphoric acid, and destruction of the bezoar’s structure by CO2 bubbles4,5.

In conclusion, we successfully treated a case of esophageal obstruction due to a bezoar, utilizing a combined treatment: endoscopic forceps, endoscopic injection, and oral intake of a cola-type carbonated soft drink. This method proved to be rapid, effective, and safe.

Ethical considerations

Study approval statement: Ethics approval was not required by the Ethics Committee of the Hospital Nuestra Señora de Sonsoles, as there is no information revealing the subject’s identity.

Consent to publish statement: The authors confirm that the patient gave his written consent, permission to publish the present article.

Financial disclosure

No specific grants were received from public sector agencies, the business sector, or non-profit organizations, in relation to this article.

Conflict of interest

The authors declare that there is no conflict of interest.

Author contributions

M.M.M conceived the idea, developed it, and took the lead in writing the manuscript. P.S.A provided critical feedback and helped shape the manuscript. M.P.D.A and R.V.H supervised the work. All authors discussed the results and contributed to the final manuscript.

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Please cite this article as: Muñiz-Muñoz M, Segovia-Alonso P, Delgado-Álvarez MP, Villanueva-Hernández R. Bezoar esofágico: un abordaje multidisciplinario. Rev Gastroenterol Méx. 2022;87:394–396.

Copyright © 2022. Asociación Mexicana de Gastroenterología
Revista de Gastroenterología de México

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