Systematic review: Coca‐Cola can effectively dissolve gastric phytobezoars as a first‐line treatment

Summary Background Gastric phytobezoars represent the most common bezoars in patients with poor gastric motility. A variety of dissolution therapies and endoscopic fragmentation techniques have been evaluated as conservative treatment so as to avoid surgery. Aim To investigate the effectiveness of Coca‐Cola for gastric phytobezoars dissolution. Methods We performed a systematic search to identify publications on gastric phytobezoars to assess the efficacy of Coca‐Cola as a dissolution therapy. Diospyrobezoars, formed after persimmon ingestion, are a distinct type of phytobezoars characterized by their hard consistency. Thus, these two subgroups of bezoars were compared in terms of successful dissolution. Results Over a 10‐year period (2002–2012), 24 papers including 46 patients have been published. In 91.3% of the cases, phytobezoar resolution with Coca‐Cola administration was successful, either as a single treatment (50%) or combined with further endoscopic techniques, whereas only 4 patients underwent surgery. Phytobezoars were more likely to dissolve after initial attempt with Coca‐Cola compared with diospyrobezoars (60.6% vs. 23%, P  = 0.022). Conclusions Coca‐Cola alone is effective in gastric phytobezoar dissolution in half of the cases and, combined with additional endoscopic methods, is successful in more than 90% of them.