Gastric bezoars, especially giant phytobezoars, are challenging to manage endoscopically due to their large size and dense composition. Conventional endoscopic tools often fail to fragment them effectively, leading to prolonged procedures, incomplete removal, or the need for invasive surgical intervention, which carries higher risks and longer recovery.

We developed a novel, low-cost endoscopic device comprising two outer sheaths attached to the endoscope and a yellow zebra guidewire forming an adjustable snare. This simple, mechanically-driven design allows real-time snare size adjustment for precise and efficient bezoar fragmentation, without requiring specialized or expensive equipment. The device is easy to assemble and deploy, making it particularly suitable for resource-limited settings.

The device was used in 9 patients with giant gastric bezoars (mean size ~4.3×7.8 cm). All bezoars were successfully fragmented and removed in a single session, with a mean procedure time of 66 minutes. No complications occurred, and follow-up gastroscopy confirmed complete clearance. All patients showed symptom resolution and were discharged after an average hospital stay of 2.5 days.

Table 1 Clinical characteristics and surgical information of included patients with gastric bezoars.

This novel endoscopic device offers a safe, effective, and economical solution for the fragmentation and removal of giant gastric bezoars, avoiding the need for surgery. Its simplicity, high success rate, and minimal complication profile support its potential for widespread clinical adoption, particularly in regions with limited access to advanced endoscopic tools.