title: Persimmon bezoars: a successful combined therapy.
abstract: BACKGROUND
  Persimmon phytobezoar, although an infrequent entity, is not rare in some countries. Because of their particular features, management of diospyrobezoars is difficult. A number of surgical, endoscopic, and pharmacologic treatments have been proposed with variable success. This is a description of our experience with 10 patients with a new combination therapy.
  
  
  METHODS
  Ten patients (7 men, 3 women; mean age 46.4 years) were treated with a new fragmentation technique consisting of a saw-like effect with a large polypectomy snare followed by administration of cellulase, cysteine, and metoclopramide.
  
  
  RESULTS
  Resolution was achieved in 8 patients. Complications (intestinal obstruction) developed in 2 patients.
  
  
  CONCLUSIONS
  Our combined therapy is safe and highly efficacious but caution must be exercised because intestinal obstruction can occur if large fragments pass through the pylorus. A more extensive study is required to assess these clinical observations.
authors.affiliation: Endoscopy Unit, Gastroenterology Department, Son Dureta Hospital, Palma (Mallorca), Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Gayà
authors.forename: Lluis
authors.initials: L
authors.lastname: Barranco
authors.forename: Alfred
authors.initials: A
authors.lastname: Llompart
authors.forename: Josep
authors.initials: J
authors.lastname: Reyes
authors.forename: Antoni
authors.initials: A
authors.lastname: Obrador
mesh_terms: D001630:Bezoars / Q000628:therapy*; D002480:Cellulase / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003545:Cysteine / Q000627:therapeutic use; D029788:Diospyros; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D013270:Stomach
chemical_list: D005765:Gastrointestinal Agents; D002480:Cellulase; D003545:Cysteine; D008787:Metoclopramide