Recurrent gastric bezoars. A new approach to treatment and prevention.

A recurrent gastric phytobezoar was successfully dispersed using an endoscopically directed intermittent jet of dilute papain. Dissolution analysis of a retrieved bezoar fragment showed pancrelipase and Adolph's Meat Tenderizer to be effective specific solvents. The patient remained free of symptoms while on a prophylactic regimen of pancrelipase taken daily. However, when the patient discontinued his medication, the bezoar recurred. The dissolution process was successfully repeated. Selecting a reagent on the basis of demonstrated effectiveness should enhance the chance of successful dissolution of a phytobezoar, whereas prophylactic doses of the reagent may prevent its recurrence.