In an 88-year-old woman, gastric outlet obstruction (GOO) caused a large kaki phytobezoar in the duodenal bulb that almost completely occluded the duodenal lumen as demonstrated by abdominal CT and upper endoscopy. Bezoars account for less than 0.4% of all GOO cases, and duodenal bezoars are exceptionally rare, especially in elderly patients. After three days of unsuccessful chemical dissolution with a solution of sodium bicarbonate and Coca-Cola, the patient underwent two endoscopic fragmentations using rat tooth forceps, traps and baskets. More than ten persimmon seeds were extracted during the procedure. Repeated endoscopy confirmed complete removal of the bezoar with two necrotic decubitus in the duodenal bulb. The patient recovered well, was discharged 4 days after the second fragmentation, and remained asymptomatic during 3 months of follow-up. This case demonstrates the success of endoscopic treatment of GOO caused by duodenal phytobezoar in an elderly patient using simple instruments suitable for resource-limited settings.