Endoscopic Removal of Large Gastric Phytobezoar

Background: Phytobezoars are large conglomerates of vegetable fiber in the intestinal tract. The most common occuring site is in the stomach. There are many therapeutic modalities for managing gastric bezoar. Previously laparotomy has been the procedure of choice for the removal of Iarge bezoars. With the advent of therapeutic endoscopy, it became feasible to manage such lesions through the endoscopic removal. But still, large gastric bezoars are difficult to remove endoscopically. We have experienced a case of huge phytobezoar managed by endoscopically using both electrohydraulic and mechanical methods. Case: 71 year old female patient was admitted due to upper gastrointestinal bleeding. Urgent endoscopic examination revealed large bleeding ulcer at the gastric angle and also over 158 cm sized hard greenish bezoar occupymg almost entire gastric body. Bleeding was controlled by epinehrine injection but because of her decreased cardiac function (ischemic cardiomyopathy; ejection fraction