Comment on “Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy”

الملخص EN

We read with great interest the article by Kao et al.

[1] published in the September 2015 issue of Case Reports in Medicine, which highlighted how important is the careful attention to airway management during esophagogastroduodenoscopy for removal of a trichobezoar and similar foreign body.

However, until today, it is still controversial which is the best option for the treatment of gastric bezoar.

Endoscopic therapy can be efficient for bezoars composed of milk curd (lactobezoars) and vegetable matter (phytobezoars) because usually they are small in size, but it is difficult to be efficient for trichobezoars, especially those that are large (>20 cm) [2].

Several factors should be taken into consideration before the final decision, such as the presence of complications and the trichobezoar’s consistency as well as the size and localization.

The complications during the esophagogastroduodenoscopy for removal of a trichobezoar are estimated which are not uncommon but just unreported.

Park et al.

[3] have reported a 12.8% morbidity rate for endoscopic treatments of 39 patients.

In another earlier study, Erzurumlu et al.

[4] reported a 14% endoscopic morbidity rate, while Spyridon et al.

[5] have reported only 11% morbidity rate.

The most common complications that have been reported after treatment are bleeding, obstruction, ileus, fever, and perforation.

Last but not least, piecemeal removal of large size lesions should be avoided because secondary bezoars are possible to migrate leading to more complications.