Endoscopic lithotripsy combined with drug lithotripsy vs. drug lithotripsy for the treatment of phytobezoars: analysis of 165 cases

• Published in: Surgical endoscopy Vol. 38; no. 5; pp. 2788 - 2794
• Main Authors: Zheng, Xiao, Qiu, Bin, Jin, Xiao-wei, Liu, Lin-na, Wang, Peng, Yu, Hai-jing, Zhang, Juan, Geng, Wen-jing, Wang, Rui, Liu, Hua
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2024; Springer Nature B.V
• Subjects: Abdomen; Abdominal Pain - etiology; Abdominal Pain - therapy; Abdominal Surgery; Aged; Bezoars - therapy; Cellulose; Combined Modality Therapy; Drug therapy; Endoscopy; Female; Gastroenterology; Gynecology; Hepatology; Hospitalization; Humans; Intestinal obstruction; Lithotripsy; Lithotripsy - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Patients; Proctology; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - therapeutic use; Retrospective Studies; Small intestine; Sodium; Sodium Bicarbonate - administration & dosage; Sodium Bicarbonate - therapeutic use; Stomach; Surgery; Treatment Outcome; Ulcers; Phytobezoar; Endoscopic lithotripsy; Sodium bicarbonate; Drug lithotripsy
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-024-10741-x

Aim To analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars. Methods We collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B). Results The median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A. Conclusion Drug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.