Endoscopic evaluation of bezoars and foreign bodies in inflammatory bowel diseases

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Introduction

Bezoars in the gastrointestinal tract are accumulated indigestible foreign materials, which can produce concretions. According to their compositions, Bezoars have been classified into following types: (1) phytobezoars (vegetable or fruit fibers), (2) lactobezoars (milk or dairy proteins), (3) trichobezoars (hairs), (4) lithobezoars (calcified, stone-like materials), and (5) pharmacobezoars (medications) . Besides, the retention of video capsule endoscope in patients with inflammatory bowel disease (IBD) can occur, especially in those with strictures or bowel-altering surgeries. Capsule retention has been a well-recognized adverse sequala in clinical practice .

Approximately 70%–80% of patients with Crohn’s disease (CD) would eventually require surgery for medically refractory disease, particularly those with strictures, fistulas, or abscesses. Commonly performed surgical modalities in CD include bowel resection and anastomosis, strictureplasty, and ileostomy. Patients with strictureplasty are prone to the development of retention of foods or bezoars. In contrast, it is estimated that 20%–30% of patients with ulcerative colitis (UC) would require colectomy for medically refractory disease, poor tolerance of medications, or colitis-associated neoplasia. Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) with “J” or “S” pouches is most commonly performed in these patients. The construction of continent ileostomies, such as Kock pouch or Barnett Continent Intestinal Reservoir, is an alternative option, for selected patients with poor anal sphincter function who are not candidates for or failed pelvic pouches. The presence of the nipple valve in the Kock pouch or Barnett pouch makes the patient vulnerable to the development or retention of bezoars or foreign bodies .

Staple techniques have been extensively used in UC or CD surgeries. Misfired or dislodged staples during or after surgery can result in pain, bleeding, or anemia.