Clinical Endoscopy

Systematic Review and Meta-analysis

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis: Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari; Clin Endosc 2025;58(2):240-252. Published online February 3, 2025; DOI: https://doi.org/10.5946/ce.2024.120

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

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Original Article

Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea: Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee; Clin Endosc 2024;57(6):790-797. Published online September 23, 2024; DOI: https://doi.org/10.5946/ce.2024.110

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

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Review

Colon stenting as a bridge to surgery in obstructive colorectal cancer management: Dong Hyun Kim, Han Hee Lee; Clin Endosc 2024;57(4):424-433. Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.138

Abstract PDF

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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Focused Review Series: The Roles of Endoscopy in the Management of Colonic Obstruction and Perforation

Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction: Su Jin Jeong, Jongha Park; Clin Endosc 2020;53(1):18-28. Published online October 24, 2019; DOI: https://doi.org/10.5946/ce.2019.058

Abstract PDF

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

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Case Reports

Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito; Clin Endosc 2018;51(3):299-303. Published online April 18, 2018; DOI: https://doi.org/10.5946/ce.2018.005

Abstract PDF

Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.

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Efficacy of endoscopic ultrasound‐guided gastroenterostomy using self‐expandable metallic stent for afferent loop syndrome: A single‐center retrospective study
Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
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Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy
Takashi Ito, Masaaki Shimatani, Masataka Masuda, Koh Nakamaru, Toshiyuki Mitsuyama, Norimasa Fukata, Tsukasa Ikeura, Makoto Takaoka, Kazuichi Okazaki, Makoto Naganuma
DEN Open.2023;[Epub] CrossRef
Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
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Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
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Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
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Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction: Ju Hyoung Lee, Kyeong Min Jo, Tae Oh Kim, Jong Ha Park, Seung Hyun Park, Jae Won Jung, So Chong Hur, Sung Yeun Yang; Clin Endosc 2016;49(6):570-574. Published online October 13, 2016; DOI: https://doi.org/10.5946/ce.2016.022

Abstract PDF

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

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Brunner's Gland Hamartoma: Masquerading as a Duodenal Mass
Dirin Ukwade, Sana Hussain, Saaed Ali, Brian Boulay
Clinical Case Reports.2025;[Epub] CrossRef
Rare Etiologies of Upper Gastrointestinal Bleeding: A Narrative Review
Ion Dina, Maria Nedelcu, Claudia Georgeta Iacobescu, Ion Daniel Baboi, Alice Lavinia Bălăceanu
Journal of Clinical Medicine.2025; 14(14): 4972. CrossRef
Adenomatous Hyperplasia of Duodenal Brunner's Glands: An Extremely Uncommon Imitation of Malignant Pathology
Archit Garg, Vikram Jeet Singh Gill, Mehak Bassi, Andrew Korman, Arkady Broder
Cureus.2025;[Epub] CrossRef
Brunner’s gland hamartomas: Not always benign
Manar Shmais, Ahmad Mousawi, Fadi Mourad, Ala I. Sharara
Arab Journal of Gastroenterology.2024; 25(1): 70. CrossRef
The Characteristics and Treatment Outcomes of 71 Duodenal Brunner’s Gland Adenomas with Endoscopic Submucosal Dissection
Ying Xiang, Jinyan Liu, Nan ya Wang, Dehua Tang, Lei Wang, Ping xiao Zou, Guifang Xu, Qin Huang
Digestive Diseases.2023; 41(6): 852. CrossRef
Giant brunner gland hamartoma: An unusual cause of upper gastrointestinal bleed
Bershic Valantine, ManjunathB Venkatapur, Sultan Nawahirsha, SBabu Kumar
Gastroenterology, Hepatology and Endoscopy Practice.2023; 3(3): 90. CrossRef
A giant Brunner’s gland hamartoma being treated as a pedunculated polyp: a case report
Lizhi Yi, Zhengyu Cheng, Huarong Qiu, Jianjun Yang, Tao Wang, Ke Liu
BMC Gastroenterology.2019;[Epub] CrossRef

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Endoscopic Removal of Small Bowel Bezoars using Colonoscopy through the Oral Approach: Su Jung Baik, M.D., Ki-Nam Shim, M.D., Seong-Eun Kim, M.D., Hye-Kyung Jung, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Joo-Ho Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(4):276-279. Published online October 30, 2008

Abstract PDF: Bezoars are accumulations of foreign materials and foods in the gastrointestinal tract and can be the cause of small bowel obstruction. A bezoar usually begins as a gastric phytobezoar that migrates to the small bowel in patients who have undergone gastric surgery and have delayed gastric emptying. We report a case of diagnosed small bowel obstruction due to the presence of a persimmon phytobezoar (diospyrobezoar) in a patient with a history of gastric surgery. Abdomen-pelvis computed tomography demonstrated the presence of an air-containing localized lesion (5×3.5 cm), a suspicious bezoar in the jejunum. The gastroduodendoscopy failed to reach to the lesion but diospyrobezoars were found in the proximal jejunum at 120 cm from the upper incisors using a colonoscope inserted using the oral approach. Most of the bezoars were fragmented by a tripod and were removed with a snare. The patient was discharged after symptomatic improvement without surgery. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2008; 37:276-279)

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A Case of Small Intestinal Obstruction due to Bezoars Accompanied with Sump Syndrome: Joo Hee Kim, M.D., Kyo-Sang Yoo, M.D., Hyoung-Chul Park M.D.*, Tae Kyung Lim, M.D., Sun You Moon, M.D., Youn Son Chung, M.D., Su Mi Yoon, M.D., Kyoung Oh Kim, M.D., Yong Woo Chung, M.D., Cheol Hee Park, M.D., Taeho Hahn, M.D., Sang Hoon Park, M.D., Jong H; Korean J Gastrointest Endosc 2008;36(4):228-232. Published online April 30, 2008

Abstract PDF: Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome. (Korean J Gastrointest Endosc 2008;36:228-232)

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A Comparison of the Use of Self-Expanding Metallic Stent Insertion with Emergency Surgery as an Initial Treatment for Obstructive Colorectal Cancer: Jung Pil Suh, M.D., Sang Woo Kim, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D.,Yu Kyung Cho, M.D., In Seok Lee, M.D., Myung Gyu Choi, M.D., Kyu Yong Choi, M.D.,In Sik Chung, M.D., Won Kyung Kang, M.D.* and Seong Taek Oh M.D.*; Korean J Gastrointest Endosc 2007;35(5):321-327. Published online November 30, 2007

Abstract PDF: Background
/Aims: Emergency surgery for obstructive colorectal cancer is associated with a high rate of postoperative complications. The objective of this study is to investigate the clinical difference between the use of elective surgery after stent insertion, and the performance of emergency surgery as an initial treatment for colorectal cancer with an intestinal obstruction. Methods: For patients that were admitted from February 2004 to June 2006 for obstructive colorectal cancer, a retrospective analysis on the clinical outcome was performed for a group of patients that received a stent as an initial treatment (stent group) and a group of patients that received emergency surgery as an initial treatment (emergency operation group). Results: Postoperative complications in the stent group included pneumonia and wound infection (9.5%). For the emergency operation group, postoperative complications included sepsis, deep vein thrombosis, wound infection, anastomosis leakage and postoperative bleeding (38.9%). The number of postoperative complications were significantly less in patients in the stent group than for patients in the emergency operation group (p=0.032). The number of a one-staged operation was significantly higher in the stent group compared with the emergency operation group (85.7% vs 55.6%; p=0.039). The number of a stoma created at least once was significantly lower in the stent group (14.3% vs 50%; p=0.017) than in the emergency operation group. Conclusions: As an initial treatment for an obstructive colorectal cancer, the use of stent insertion for primary management should be considered since it can reduce the degree of postoperative complications and the necessity for multi-staged operations. (Korean J Gastrointest Endosc 2007;35:321-327)

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Efficacy of Niti-S ComVi Stents for Palliation of Malignant Gastrointestinal Obstruction: Seong Eun Kim, M.D., Jeong Seop Moon, M.D., Jin Kwang Lee, M.D., Jin Gook Huh, M.D., Jong Sung Lee, M.D., Tae Yeob Jeong, M.D., Soo Hyung Ryu, M.D., Jung Whan Lee, M.D. and You Sun Kim, M.D.; Korean J Gastrointest Endosc 2007;34(4):185-192. Published online April 30, 2007

Abstract PDF: Background
/Aims: Niti-S ComVi stents are flexible and retain the shape-memory of the original configuration. ComVi stents are effective in preventing tumor ingrowth because polytetrafluoroethylene is inserted between two stent wires. The aim of this study was to examine the efficacy of Niti-S ComVi stents for the palliation of a malignant gastrointestinal obstruction. Methods: Between April 2004 and April 2006, 17 patients (20 cases) underwent Niti-S ComVi stenting, using a through-the- scope method. The technical and clinical success, complication, and outcome were analyzed. Results: Stent insertion was technically successful in 18 cases (90%). Malposition to the afferent loop occurred in 2 cases. Symptomatic improvement was achieved in 14 cases (70%). The mean gastric outlet obstruction score was 0.2 before stenting and 1.6 after stenting. The complications encountered were stent migration (2 cases) and obstruction (5 cases), which were treated by re-stenting and balloon dilatation. Twelve patients died with a median survival of 67 days. Five patients were still alive with a median follow up of 151 days. The overall median stent patency time was 60 days. The mean waist diameter of the stents was expanded to 57% of full expansion immediately after deployment, and 77% after 36 hours. Conclusions: Niti-S ComVi stenting is an effective palliative technique for inoperable or postoperative recurrent tumors, and significantly improves the quality of life. (Korean J Gastrointest Endosc 2007; 34:185⁣192)

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A Case of Partial Intestinal Obstruction due to Ascaris lumbricoides: Won Yong Shin, M.D., Han Hyo Lee, M.D., Young Hye Byun, M.D., Jeong Seon Kim, M.D., Eun Young Lee, M.D., Seong Hwan Kim, M.D., Moon Hee Song, M.D., Yun Ju Jo, M.D., Young Sook Park, M.D. and Dong Hoon Kim, M.D.*; Korean J Gastrointest Endosc 2006;32(3):221-225. Published online March 30, 2006

Abstract PDF: Ascaris lumbricoides (A. lumbricoides) is the largest and most common human intestinal helminth in the world. However, the prevalence of ascariasis has, in recent years, been very low in Korea. The majority of patients infected with A. lumbricoides are asymptomatic. However, sometimes these infections may give rise to intestinal obstructions or pancreatobiliary disease, via retrograde migration through the ampulla of Vater. Intestinal obstruction associated with A. lumbricoides is a complication that is frequently observed in children living in endemic areas. However, no cases of A. lumbricoides-associated intestinal obstruction have been reported in Korea since 1967. In this report, we describe the case of a 78-year-old man, who presented with sustained nausea and postprandial vomiting, and was diagnosed with a partial intestinal obstruction due to A. lumbricoides after undergoing an esophagogastroduodenoscopy. (Korean J Gastrointest Endosc 2006;32:221⁣225)

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A Case of Superior Mesenteric Artery Syndrome Treated by Laparoscopic Surgery: Ji-Sung Chun, M.D., Woo-Chul Chung, M.D., Seong-Su Hwang, M.D.*, Hyun-Min Cho, M.D.^†, Kang-Moon Lee, M.D., Bo-In Lee, M.D., Su-Yeon Lee, M.D., Ji-Won An, M.D., U-Im Chang, M.D., Jin-Mo Yang, M.D., Kyu-Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;32(3):215-220. Published online March 30, 2006

Abstract PDF: Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction. (Korean J Gastrointest Endosc 2006;32:215⁣220)

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Effectiveness of Through-the-scope Self-expandable Metal Stent in Malignant Upper Gastrointestinal Obstruction: Eun Soon Kim, M.D.*, Jeong Seop Moon, M.D., You Sun Kim, M.D., Il Kim, M.D., Jin Kwang Lee, M.D., Seong Eun Kim, M.D., Soo Hyung Ryu, M.D. and Jung Whan Lee, M.D.; Korean J Gastrointest Endosc 2005;31(1):1-9. Published online July 30, 2005

Abstract PDF: Background
/Aims: Self-expandable metal stents (SEMS) have been used in the palliation of malignant obstruction. The purpose of this study was to evaluate the effectiveness, safety, and outcome of SEMS using through-the- scope (TTS) method in the patients with malignant upper gastrointestinal obstruction including recurrent gastric cancer after gastrectomy. Methods: Thirty one patients (36 stents) were treated with SEMS between October 2000 and June 2004; nineteen had inoperable malignant gastric outlet obstruction, ten had recurrent gastric cancer after gastrectomy, and two had metastatic duodenal cancer. We analyzed the technical and clinical success, complication, and outcome. Results: The technical success rate was 88.8% (32/36 stents) in total cases; 95.0% (19/20) in malignant gastric outlet obstruction, 84.6% (11/13) in recurrent gastric cancer after gastrectomy, and 66.7% (2/3) in metastatic duodenal cancer. The success rate of dietary intake was 86.1% (31/36 stents). Complications occurred in 7 of 36 stents (19.4%), including stent migration (1 patient), aspiration pneumonia (1 patient), and recurrent obstruction (5 patients). The mean survival duration period was 118.1⁑180.2 days and mean patency period was 92.2⁑89.9 days. Conclusions: SEMS using TTS is an effective, safe, and less invasive palliative treatment in malignant upper gastrointestinal obstruction including recurrent gastric cancer after surgery. (Korean J Gastrointest Endosc 2005;31:1⁣9)

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특발성 과호산구 증후군 환자에서 발생한 장 폐색증 1 예 ( A Case of Idiopathic Hypereosinophilic Syndrome Accompanied with Intestinal Obstruction ): Korean J Gastrointest Endosc 2001;23(4):245-250. Published online November 30, 2000

Abstract PDF: The idiopathic hypereosinophlic syndrome (HES) is a disease defined by three diagnostic criteria, first, sustained blood eosinophilia is greater than 1,500/mm3 present for longer than 6 months, second, other apparent etiologies for eosinophilia must be absent, including parasitic infection and allergic disease, third, patients must have signs and symptoms of organ involvement. It is associated with cytotoxic granule proteins released by mature eosinophils. HES mainly affects cardiovascular, neurologic, pulmonary system, liver and apleen while low incidence of gastrointestinal involvement is found, and the development of severe complications such as intestinal obstruction after peritonitis or intestinal perforation is extremely rare. We have experienced a case of HES involving hepatic and digestive system, 39 year old man patient who was operated due to intestinal obstruction that was followed by HES, so we report this case with a review of the literature. (Korean J Gastrointest Endosc 2001;23:245-250)

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증례 : 식도 위장관 ; 소장 폐색을 보였던 위석 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Small Intestinal Obstruction Due to a Fragment of Gastric Phytobezoar ): Korean J Gastrointest Endosc 1996;16(4):658-665. Published online November 30, 1995

Abstract PDF: Phytobezoar is rare disease in the stomach and small bowel of the patient without underlying previous gastroenterologic pathology. Because it usually occurs secondarily to peptic ulcer surgery, poor mastication, diabetes mellitus, hypothyroidism and connetive tissue disease. In morden medicine, phytobezoars found in the stomach and/or intestines in humans, are known to be associated with considerable morbidity and even mortality. Patients with gastric bezoar present with chronic postprandial epigastic pain, nausea, and vomitihg. It is diagnosed by endoscopic examination or radiologic study and treated by surgical removal or non-surgical methods including conservative treatment, enzymatic dissolution, and endoscopic removal. We have experienced a case of small intestinal obstruction due to a fragment of gastric bezoar of the patient without underlying etiologic cause. So we report the case with a brief review of literatures. (Korean J Gastrointest Endosc 16: 658-668, 1996)

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