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We present the case of a 57-year-old man who was admitted for weight loss (>15% in 4 months) and recurrent vomiting. His medical history included type II diabetes mellitus and a gastroduodenal surgery 15 years before due to complicated peptic ulcer disease. On admission, he was malnourished and severely dehydrated. An abdominal computed tomography showed marked gastric distension due to partially occlusive heterogeneous luminal content in the antrum and proximal duodenum. On upper gastrointestinal endoscopy, a Billroth I partial gastrectomy was observed. A bulky bezoar extending from the distal body to the gastroduodenal anastomosis was identified and successfully broken up in fragments of <2 cm, using foreign body forceps and a polypectomy snare, after through-the-scope irrigation and needle injection with Coca-Cola® (Figure 1a, b). After the procedure, a solid diet was restarted. The patient became asymptomatic and was discharged the following day. He was advised to ingest large amounts of Coca-Cola® for a few weeks. After 3 days, he was readmitted because of recurrent vomiting, dehydration, and oral feeding intolerance. On endoscopy, his stomach was empty, but a striking distension of the duodenum and jejunum, filled by liquid and undigested material, prevented mucosal examination. Total parenteral nutrition was started to control malnutrition, and a magnetic resonance enterography performed 1 week later showed a 5.6×3.8-cm bezoar in the distal

Small bowel obstruction after endoscopic fragmentation of a gastric bezoar: An unexpected complication