Importance of second-look endoscopy on an empty stomach for finding gastric bezoars in patients with gastric ulcers

Masaya Iwamuro, Shouichi Tanaka, Yuki Moritou, Tomoki Inaba, Reiji Higashi, Chiaki Kusumoto, Naoko Yunoki, Shin Ishikawa, Yuko Okamoto, Yoshinari Kawai, Ken ichi Kitada, Ryuta Takenaka, Tatsuya Toyokawa, Hiroyuki Okada

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Most gastric bezoars can be treated with endoscopic fragmentation combined with or without cola dissolution, whereas laparotomy or laparoscopic surgery is generally inevitable for small intestinal bezoars because they cause small bowel obstruction. Therefore, early diagnosis and management of gastric bezoars are necessary to prevent bezoar-induced ileus. To investigate the incidence of overlooked gastric bezoars during the initial esophagogastroduodenoscopy, we retrospectively reviewed the cases of 27 patients diagnosed with gastrointestinal bezoars. The bezoars were diagnosed using esophagogastroduodenoscopy (n=25), abdominal ultrasonography (n=1), and barium follow-through examination (n=1). Bezoars were overlooked in 9/25 patients (36.0%) during the initial endoscopy examination because the bezoars were covered with debris in the stomach. Of the 9 patients, 8 had concomitant gastric ulcers, and the other patient had gastric lymphoma. Although a computed tomography (CT) scan was performed before the second-look endoscopy in 8 of the 9 patients, the bezoars were mistaken as food debris on CT findings and were overlooked in these patients. In conclusion, gastric bezoars may not be discovered during the initial esophagogastroduodenoscopy and CT scan. In cases with debris in the stomach, second-look endoscopy is essential to detect bezoars.

Original languageEnglish
Pages (from-to)241-247
Number of pages7
JournalActa medica Okayama
Issue number3
Publication statusPublished - 2017


  • Bezoar
  • Foreign bodies
  • Gastric ulcer
  • Phytobezoar

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology


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