LAUSR

A 56-year-old woman presented to our department with a 1-day history of hematemesis and a 2-year history of eating persimmons. After the patient had received an injection of proton pump inhibitor, we found a giant phytobezoar (about 6×4 cm) in her stomach on gastroscopy (▶Fig. 1 a). The phytobezoar was turned into an upright position with the endoscope in the inverted position (▶Video 1). A large snare (4 cm in diameter) was used to trap the phytobezoar (▶Fig. 1b); however, it was hard to crush the phytobezoar when tightening the snare. Therefore, the tightened snare was pulled into the cap to cold-cut the phytobezoar using cap assistance. After repeated snare-trapping and cap-assisted cold-cutting, the phytobezoar was finally cut into several pieces. The larger pieces were pulled out using the snare (▶Fig. 2); the leftover small pieces were washed out of the body using oral polyethylene glycol. A subsequent gastroscopy, 2 days after the cap-assisted coldcutting snare removal procedure, revealed a clear stomach (▶Fig. 3). Gastric bezoars can be removed by drinking coco-cola, or the use of forceps, snare, or DualKnife [1, 2]; however, a giant gastric bezoar is difficult to remove. A previous report described cap-assisted cold snare removal of a small cyanoacrylate glue bezoar [3]. Herein, we show that a cap-assisted cold snare technique can also be used to easily remove giant phytobezoars with large diameters.