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We report a young healthy woman, who believed that the consumption of large amounts of honeycomb would lead to good health and who finally developed a huge gastric bezoar of hard consistency. The conventional endoscopic techniques failed to manage the bezoar. Using the combination of injection of hydrogen peroxide 3% solution inside the bezoar to induce disintegration and a special designed needle-knife sphincterotome (bezotome) we managed to remove the bezoar in fragments. To the best of our knowledge this is the first reported bezoar caused by honeycomb.

We herein describe the first case of a high elderly patient with severe dysphagia in solids and liquids, caused by a huge epiphrenic diverticulum, who was treated with combined therapy of balloon dilation and botulinum toxin injection. Due to comorbid associated diseases the patient was unsuitable to withstand surgical or laparoscopic intervention. Treatment with botulinum toxin injection at the region of lower esophageal sphincter was unsuccessful. Combined therapy with balloon dilatation and botulinum toxin injection at the compressed part of esophageal lumen by the diverticulum resulted in improvement in dysphagia and malnutrition. During the long-term follow-up the patient developed symptomatic relapses, successfully treated by subsequent combined therapy resulting in longer-lasting symptom relief.