Endoscopic Treatment of a Giant Gastric Bezoar: Sequential Use of Alligator Forceps and Snare Fragmentation.

We report the case of a 79-year-old man with a giant gastric diospyrobezoar (50 × 30 mm) who presented with epigastric pain. Two weeks of cola dissolution therapy at home was ineffective. During endoscopy, alligator forceps were used to create grooves on the hard, smooth surface of the bezoar, enabling a 30-mm polypectomy snare to fragment the bezoar into pieces smaller than 1 cm. Residual fragments passed spontaneously, and complete resolution was confirmed by follow-up endoscopy three weeks later. The patient was discharged on postprocedure day 3 without complications. This case demonstrates that the sequential use of alligator forceps and a polypectomy snare can be an effective endoscopic technique for giant gastric bezoars with hard, smooth surfaces, potentially avoiding surgical intervention even in high-risk elderly patients.