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DOI: 10.1055/a-2562-4179
Endoscopic removal of a large gastric trichobezoar using a snare modified from a lithotripter to facilitate argon plasma coagulation
Trichobezoars, rare gastric bezoars made of hair, are most common in young girls with psychiatric disorders. They usually accumulate in the stomach and may extend into the small intestine, known as Rapunzel syndrome [1]. Patients often present with obstruction, bleeding, or perforation. Larger trichobezoars typically require surgery due to the challenges of endoscopic treatment [2] [3] [4]. Here, we report a successful endoscopic retrieval of a large gastric trichobezoar using a snare made from the core of a lithotripter to assist in argon plasma coagulation ([Video 1]).
Quality:
A 16-year-old girl with autism presented with upper gastrointestinal obstruction. Endoscopy showed a large gastric trichobezoar mixed with string and plastic ([Fig. 1]). The trichobezoar extended from the gastric fundus to the pylorus, partially into the descending part of the duodenum ([Fig. 2]), making it too large for a polypectomy snare or lithotripter to encircle.
To address this, we modified the lithotripter by cutting the core wire and forming loops at both ends to create a snare wire ([Fig. 3]). First, one loop was secured to the anterior gastric wall near the location of the trichobezoar using a titanium clip ([Fig. 4] a). An overtube was placed, and a polypectomy snare was positioned over the transparent cap before advancing the endoscope. The other loop was held with foreign body forceps and passed from the posterior wall of the stomach along the greater curvature, encircling the trichobezoar, until it converged with the loop fixed to the anterior wall ([Fig. 4] b, c). The snare was released to encircle the wire loop, and both loops were grasped with forceps ([Fig. 4] d, e). The forceps and snare were tightened, guiding the trichobezoar to the lower esophagus, and the endoscope was withdrawn ([Fig. 4] f). The other endoscope was inserted and argon plasma coagulation was applied along the snare wire to fragment the trichobezoar. By repeating the aforementioned steps, the trichobezoar was completely removed ([Fig. 5]).
Endoscopy_UCTN_Code_TTT_1AO_2AL
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Publication History
Article published online:
03 April 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Li Y, Lu J, Lei W. et al. A simple endoscopic treatment for large gastric bezoars: the guidewire and snare method. Endoscopy 2022; 54: E1058-E1059
- 2 Patil M, Gharde P, Shinde RK. et al. Rapunzel syndrome: diagnostic challenges and multidisciplinary treatment strategies. Cureus 2024; 16
- 3 Baek SG, Oh CH, Shin GY. et al. Endoscopic retrieval of a huge gastric trichobezoar using an electrosurgical knife. Endoscopy 2021; 53: E357-E358
- 4 Benatta MA. Endoscopic retrieval of gastric trichobezoar after fragmentation with electrocautery using polypectomy snare and argon plasma coagulation in a pediatric patient. Gastroenterol Rep 2015; 4: 251