To the editor: Sir, Esophageal bezoars represent a rare but severe and difficult to treat complication in patients in an intensive care unit. Esophageal bezoars usually result form enteral feeding, sucralfate, administration of other antacids and from plurimedication [1]. Esophageal bezoar formation seems also to be aggravated by previous thoracic surgery, impaired esophago-gastric motility, reduced lower esophageal sphincter tone, gastroesophageal reflux [3], the presence of a prosthetic device in the esophagus, restrictive hydration and use of morphinic compounds [2]. Esophageal bezoars are known to occur more frequently in patients with structural or functional abnormalities of the esophagus such as esophagitis, mechanical irritation by the nasogastric tube and myasthenia gravis. Herein, we describe the successful management of full-length obstructing esophageal bezoars in two patients. Both patients were under mechanical ventilation and were receiving intravenous proton pump inhibitors. Nasogastric tube feeding was used for a prolonged period of time as the first patient had abdominal compartment syndrome after repetitive abdominal surgical interventions after a car accident. As to the other patient who was diagnosed with stroke, his relatives initially refused gastrostomy. Endoscopic examination revealed putty-like material consistent with coagulated enteral feeding formula filling almost all the esophageal lumen and obstructing the esophagus. All attempts to overcome obstruction were unsuccessful and the scope could not advance. Using a Roth net little by little, the coagulated material from the proximal third was removed, and then a diagnostic catheter was inserted, which was carefully advanced as much as possible between the coagulated material and the esophageal lumen. Through the catheter, coagulated material was sprayed with a 60 ml mixture consisting of 30 ml gastrografin (760 mg/ml) and 30 ml N-acetylcysteine (100 mg/ml). In one patient, the spraying procedure was required twice. Two days after the initial endoscopic intervention, an endoscopy was performed again with a pediatric type of scope. We managed to pass through a large bezoar filling the middle and distal thirds of the esophagus to visualize the stomach and to insert a guide wire through which an adult scope was inserted. Using a catheter again, we repeated ‘spaying’ through the whole length of the esophagus, and 2 days afterwards all coagulated material was completely cleared, revealing also an underlying mild esophagitis in both patients. Patients underwent endoscopic gastrostomy and live in a stable condition. The prevalence of esophageal bezoars in ICUs is currently unknown. Upper GI endoscopy is a common diagnostic and therapeutic procedure for esophageal bezoars. The bezoar can be endoscopically removed in many cases. However, in difficult cases with a solid lump, special step-by-step management is needed before a definite endoscopic treatment. Severe complications are always possible, as the scope is advanced with relative pressure in the narrow esophageal space. Pharmaceutical treatment of bezoars is still largely empirical and N-acetylcysteine with its chemical properties may be a helpful agent to liquefication [4]. Finally, administration of gastrografin has proved efficacious in difficult cases [5]. In conclusion, these are the particulars of two patients with obstructing esophageal bezoars that were successfully managed with a combined step-by-step approach through endoscopy, N-acetlycysteine and gastrografin spraying.