LAUSR

A 44-year-old man went to the local hospital with a 3-day history of nausea, vomiting, abdominal pain, and difficulty eating after drinking. Gastrointestinal endoscopy showed a kidney-shaped bezoar obstructing the esophagus at 30 cm from incisors. On esophagography, the esophageal walls were seen to be stretched thin by the large bezoar (▶Fig. 1). Computed tomography scanning showed that the bezoar, which was located in the lower esophagus, was about 30-mm wide, 25mm in the anteroposterior direction, and 53mm in length (▶Fig. 2 a, b). Multiplanar reformation showed that the bezoar was close to the major blood vessels and heart (▶Fig. 2 c). On day 4 of admission, the patient underwent laser lithotripsy. After the bezoar had been partially broken up by the lithotripsy, we attempted removal with a wireguided retrieval basket and snare, but neither were successful (▶Video 1). Laser lithotripsy was performed again. The broken bezoar fragments were then pushed into the stomach and crushed by the wire-guided retrieval basket. Once the bezoar had been removed from the esophagus, multiple ulcers, including two large ones, were seen at 30–36 cm from the incisors (▶Fig. 3 a). Following the lithotripsy procedure, the patient was treated with sodium bicarbonate to facilitate dissolution of the bezoars. At follow-up 1 month later, gastroscopy showed that the bezoars had disappeared and the esophageal ulcers were well healed (▶Fig. 3b). Esophageal bezoars are rare, in contrast to the more common gastric bezoars. Esophageal bezoars are often associated with mechanical obstruction of the esophagus or reflux of gastric bezoars [1, 2]. A bezoar that lodges in the esophagus often causes acute obstruction; its most acute onset can cause chest pain and difficulty in swallowing. If the bezoar is incarcerated in the esophagus for a longer time, the esophageal wall can ulcerate, bleed, and even perforate [3]. Usually, a wire-guided retrieval basket or snare is used as the first approach for foreign body removal in the esophagus [4, 5]; however, alternative methods to manage large foreign bodies should be considered. As in our case, the hard bezoar was E-Videos