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World J Gastrointest Endosc. 2010 Oct 16;2(10):352-6. doi: 10.4253/wjge.v2.i10.352.

Esophageal obstruction due to enteral feed bezoar: A case report and literature review.

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Esther-Lee Marcus, Ron Arnon, Arkadiy Sheynkman, Yehezkel G Caine, Chronic Ventilation Unit, Herzog Hospital POB 3900, Jerusalem 91035, Israel.


This paper describes a rare complication of enteral feeding, esophageal obstruction due to feeding formula bezoar, and reviews the published cases. An attempt to re-insert the nasogastric tube in a chronically ventilated 80-year-old female fed via a nasogastric tube with Jevity(®) failed. An esophagogastroduodenoscopy revealed an 18 cm-long concretion of the feeding formula, filling most of the esophageal lumen, which was removed endoscopically. Forty-two cases of feeding formula esophageal bezoars have been reported in the literature. The formation of feeding formula bezoars is triggered by acidic gastroesophageal reflux. The acidic pH in the esophagus causes clotting of the casein in the formula. Predisposing factors for bezoar formation are: mechanical ventilation, supine position, neurological diseases, diabetes mellitus, hypothyroidism, obesity and history of partial gastrectomy. Diagnosis and removal of the bezoar is done endoscopically. Feeding in a semi-recumbent position, administration of prokinetic agents and proton pump inhibitors may prevent this complication.


Casein; Enteral feeding; Esophageal bezoar; Nasogastric tube

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