Bezoars are classified according to their composition into trichobezoar (hair) (Figure 46.1), lactobezoar (milk), pharmacobezoar (medicines/chemicals), and phytobezoar (vegetable matter) (Figure 46.2). While most bezoars can be treated by enzymatic dissolution (with proteolytic enzymes or Coca‐Cola^TM), a trichobezoar may be a greater challenge for the endoscopist.

The gold standard for diagnosis of bezoars is endoscopy, while the treatment is either endoscopic or surgical. Surgery was the treatment of choice in the past, but endoscopy is gaining ground, being reported as the preferred treatment in 66–77% of bezoars [1,2]. Endoscopic removal is less invasive and more cost‐effective, provided that the shape and dimensions of the trichobezoar enable endoscopic retrieval. Sometimes, endoscopic treatment is not successful because of the extension of the trichobezoar tail into the small bowel, the size of the bezoar or its embedding into gastric mucosa.

The endoscopic intervention usually consists of two steps: fragmentation and removal of fragmented parts. The whole procedure can involve many passages over 3–4 hours (Figure 46.3).

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