Single-session endoscopic removal of a giant gastric diospyrobezoar in a remnant stomach using direct Coca-Cola injection and mechanical fragmentation.

A man in his seventies with a history of distal gastrectomy with Billroth I reconstruction presented with progressive anorexia and abdominal distension. Contrast-enhanced computed tomography revealed a 100 × 45 mm gas-containing intragastric mass, and upper gastrointestinal endoscopy demonstrated a giant gastric bezoar occupying the remnant stomach. Endoscopic treatment was performed using a combination approach: direct injection of Coca-Cola into the bezoar core to induce internal softening, followed by mechanical fragmentation with a polypectomy snare and grasping forceps. Residual fragments were further dissolved by topical irrigation with Coca-Cola, with a total administered volume of approximately 1800 mL. Complete removal was achieved in a single session without adverse events, and the patient was discharged 8 days after the procedure. Dietary history revealed daily consumption of 5-6 persimmons, strongly suggesting a diospyrobezoar. This case indicates that endoscopic Coca-Cola injection combined with mechanical fragmentation is an effective, safe, and minimally invasive treatment option, even for giant bezoars in post-gastrectomy remnant stomachs.