title: Frequency, manifestations and management of bezoars in ileal pouches
abstract: Background and Aim
  To evaluate the frequency, diagnosis and management of ileal pouch bezoars.
  
  Methods
  Patients diagnosed with ileal pouch bezoars at the P ouch C enter at Cleveland Clinic from 2002 to 2013 were included. Demographic, clinical and endoscopic features, management and outcomes were evaluated.
  
  Results
  Twelve patients with ileal pouch bezoars were enrolled, including five (0.4%) of 1390 patients with J ‐pouch and seven (13.0%) of 54 with continent ileostomy (P  < 0.001). Males accounted for 25% (n  = 3) of the cohort. Mean age at time of detection was 61.5 ± 10.3 years. Of the 12 patients, six (50.0%) had phytobezoars, four (33.3%) had lithobezoars, one (8.3%) had pharmacobezoar and one (8.3%) had a retained‐J ackson‐P ratt drain. Median number of harvested bezoars was one (range: 1–224), and mean diameter was 4.0 ± 2.4 cm. Bezoars were located at the pouch body in eight (66.7%) patients, pouch inlet in two (16.7%), pouch‐anal anastomosis in one (8.3%) and efferent limb in one (8.3%). Ten patients (83.3%) were symptomatic, including seven (58.3%) with partial bowel obstructive symptoms. Eleven patients (91.7%) were initially managed with endoscopic treatment including basket, R othN et® , mechanical lithotripsy T ripod and snares. After a median of one (1–3) endoscopic therapy, bezoars were successfully removed in seven patients (58.3%). Surgical intervention was required in the remaining five patients (41.7%).
  
  Conclusions
  Ileal pouch bezoars appeared to be more frequently encountered in patients with continent ileostomies than in those with J ‐pouches. Endoscopic management seemed to be effective in some patients, whereas surgical intervention was needed in others.
authors.affiliation: Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Ashburn
authors.affiliation: Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000191:economics / Q000379:methods; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D005774:Gastrostomy / Q000191:economics / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D010179:Pancreas / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
keywords: bezoar; endoscopy; ileal pouch; pouch outlet obstruction; ulcerative colitis