Endoscopic removal of esophageal bezoars using a condom as a novel retrieval device

A 64-year-old woman presented to our gastroenterology department with a 5-day history of dysphagia. She reported a history of persimmon ingestion and a 15-year history of achalasia. Gastrointestinal endoscopy revealed several diospyrobezoars retained within an epiphrenic diverticulum ([Fig. 1] a). Esophagography identified an ulcer on the diverticulum wall near the cardia ([Fig. 1] b). Computed tomography showed bezoars in the lower esophagus measuring 3.0 cm × 2.8 cm × 1.2 cm, associated with distal esophageal dilation ([Fig. 1] c). Multiplanar reformation demonstrated the bezoarʼs proximity to the left main bronchus and major blood vessels ([Fig. 1] d).

Fig. 1 Pre-procedural localization of esophageal diospyrobezoars by endoscopy and CT. a, b Endoscopic views showing the diospyrobezoars with the adjacent esophageal ulcer (the arrow in b). c, d CT scans showing diospyrobezoars within the dilated esophageal lumen, located in close proximity to the left main bronchus and major blood vessels (outlined by the orange dashed line). CT, computed tomography.

On the second day of admission, we performed the endoscopic bezoar removal. We employed a condom grasped by foreign body forceps as a retrieval bag ([Fig. 2] a), advancing and repositioning it to entrap the diospyrobezoars ([Fig. 2] b). After repeated attempts, all diospyrobezoars were successfully extracted ([Fig. 2] c, d). The procedure was completed without complications, such as perforation and bleeding ([Video 1]).

Fig. 2 Endoscopic removal of esophageal diospyrobezoars using a condom as an improvised retrieval device. a A condom is grasped with foreign body forceps. b The condom is advanced to ensnare the diospyrobezoars. c All retrieved diospyrobezoars. d A post-procedure view confirming complete removal and mucosal integrity.

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Endoscopic removal of esophageal diverticulum diospyrobezoars using an improvised condom device for entrapment and retrieval.Video 1

Postoperatively, the patient received adjunctive therapy with a proton pump inhibitor. At the 1-month follow-up, she was asymptomatic and report no chest pain or dysphagia.

Esophageal bezoars are even rarer than gastrointestinal bezoars. Their formation is strongly associated with esophageal structural and motility disorders, such as achalasia [1]. An esophageal bezoar can cause acute obstruction, gastrointestinal disturbances, ulceration, and even perforation [2] [3], as well as chest pain and dyspnea [4]. While retrieval baskets or snares are first-line interventions [5], we innovatively utilized a condom as a retrieval device. Its soft and pliable nature makes it a strategically safer choice for complex retrievals, minimizing the risk of mucosal injury.

Endoscopy_UCTN_Code_TTT_1AO_2AL

Contributorsʼ Statement

Jieru Guo: Writing – original draft. Haowei He: Investigation, Writing – original draft. Guang Song: Investigation, Writing – review & editing. Shasha Liang: Investigation, Writing – review & editing. Long Rui: Investigation, Resources, Writing – review & editing. Xun Li: Data curation, Investigation, Writing – review & editing. Shuang Liu: Project administration, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

The authors would like to express their gratitude to the doctors and nurses of the Digestive Endoscopy Center, 82nd Group Army Hospital for their hard work in performing endoscopic procedures.

• References

• 1 Kim KH, Choi SC, Seo GS. et al. Esophageal bezoar in a patient with achalasia: case report and literature review. Gut Liver 2010; 4: 106-109
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• 3 Hernandez PV, Snyder DL, Ghorab S. et al. Removal of a Large Stone in the Upper Thoracic Esophagus. Mayo Clin Proc Innov Qual Outcomes 2020; 4: 105-108
• 4 Urlapu KS, Mantri N, Patel H. et al. Severe Airway Obstruction Caused by Esophageal Bezoar with Coca-Cola and Creon (Pancrelipase) in a Patient with Underlying Achalasia: A Comprehensive Case Report. Case Rep Gastrointest Med 2024; 2024: 2081040
• 5 Michael B, Peter B, Pierre H D. et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489-496

Publication History

Article published online:
28 January 2026