Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

Peck, Jacquelin; Khalaf, Racha T.; Marth, Ryan; Phen, Claudia; Sosa, Roberto; Cordero, Francisco Balsells; Wilsey, Michael

doi:10.5223/pghn.2018.21.4.351

Cited by 9 publications

(8 citation statements)

References 6 publications

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“…Although residual web tissue was observed in a few patients, they remained symptom-free. As of endoscopic treatment, several studies have demonstrated both the strength and limitations ( 2 – 4 , 10 ). Endoscopic treatment requires suitable instrumentation, technical expertise, and multidisciplinary support ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Antral web is considered a rare cause of gastric outlet obstruction in children ( 1 ). The incidence is unclear, yet ever estimated to be 1–3 in 100,000 live births in the literature ( 2 , 3 ). The pathogenesis includes in-utero vascular accident, failure of recanalization, or an excess of localized endodermal proliferation ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

et al. 2021

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Background: Antral web is a rare cause of gastric outlet obstruction in children. The presentation is diverse, depending on the degree of obstruction. Unfortunately, the guidance of management is still lacking.Methods: This study retrospectively evaluated the presentations, management, and outcomes of the pediatric antral web based on a 20-year experience in a referral center.Results: A total of 23 cases were included. The median age of diagnosis was 10 months (interquartile range, IQR, 0.8–23 months). Main presentations comprised vomiting (83%) and upper gastrointestinal (UGI) bleeding (48%). Concurrent gastric ulcers were common (68%). A total of 13 cases (57%) underwent interventional treatment. The median duration from diagnosis to intervention (DtI) was 10 days, but five with longer DtI, ranged from 30 to 755 days. Among the 15 cases with concurrent gastric ulcers, 10 patients received intervention, immediately in six but delayed in four. Surgical treatments (N = 12) achieved a cure in 11, with one rescued by endoscopic treatment.Conclusions: Children who suffer from early gastric ulcers with outlet obstruction shall raise the suspicion of the antral web. Complete obstruction madates early intervention. Around half of the cases with adequate feeding and growth need no intervention. Recurrent obstructive symptoms or adjacent ulcers justify a switch from observation to intervention to avoid complications or growth faltering.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

et al. 2021

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“…[ 5 ] The endoscopic treatment modality for GAW is either balloon dilation or needle-knife incisions. Balloon dilation has proven to be less invasive and effective,[ 6 ] but did not always provide long-term symptom alleviation. [ 1 ] In recent years, several cases have shown that balloon dilatation combined with needle-knife incisions had low risk of perforation or significant bleeding and hence could also be a sufficient treatment modality.…”

Section: Discussionmentioning

confidence: 99%

Successful endoscopic treatment of an obstructing gastric antral web in a paediatric patient

Ren

Jiang

Wang

et al. 2021

Journal of Minimal Access Surgery

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Gastric antral web (GAW) is a rare anomaly of the gastric antrum and can result in gastric outlet obstruction. Currently, endoscopic treatment of GAW is considered challenging due to high technical requirements and restenosis. Herein, we present a rare case of a paediatric patient with GAW cured by endoscopic transection and partial resection of the web. An 8-year-old boy was admitted because of a 9-month history of postprandial fullness and intermittent non-bilious vomiting of gastric contents. On performing upper gastrointestinal contrast and gastroscopy, the diagnosis of GAW was confirmed. Then, three electroincisions were performed in a radial fashion. Moreover, about a third of the web located in the larger curvature was resected. On follow-up for 6 months, the patient was completely relieved of the postprandial fullness and non-bilious vomiting. Hence, endoscopic treatment for GAW was considered safe and effective for this case. Furthermore, partial resection of the web contributed in avoiding restenosis.

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“…Surgery is the mainstay of treatment in symptomatic patients which include web excision with or without pyloroplasty. Endoscopic dilation is gaining popularity in recent times owing to its less invasive nature and is found to be effective especially in older children (4,5).…”

Section: Gastric Outlet Obstruction Due To Antral Web In a Toddlermentioning

confidence: 99%

Tracheoesophageal Fistula after Button Battery Ingestion

Fontoura-Matias

Rebelo

Espinheira

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Image of the Month Tracheoesophageal Fistula after Button Battery IngestionA 23-month-old boy was brought to the Emergency Department (ED), 2 hours after witnessed ingestion of a button battery, without complaints and with normal physical examination. The chest x-ray found the battery in the esophagus. It was removed by endoscopy. Mitigating strategies, such as sucralfate, were avoided to not delay the endoscopy. The extraction was difficult due to adhesions to the esophagus walls and oedema. After the removal, the mucosa showed circumferential necrosis (Fig. 1); unfortunately, acetic acid for irrigation after removal was not available. A nasogastric tube for feeding was placed under endoscopic control, and piperacillin-tazobactam, omeprazole, and methylprednisolone were initiated. An esophagogram 9 days after battery removal showed no signs of complications. Without complaints, the patient was discharged the next day.He was brought again to the ED 3 days afterwards, due to wet cough with trouble breathing, and refusal to eat solids. He presented stridor and bilateral wheezes. Endoscopy showed a tracheoesophageal fistula where the battery had been (Fig. 2). Two surgeries successfully achieved fistula closure. Meanwhile, the child was kept sedated in the intensive care unit. He resumed oral feeding 19 days after the second surgery, and an esophagogram two weeks after showed no signs of stenosis or fistula.Complications due to button battery ingestion have increased, mostly due to larger batteries more prone to impaction and higher voltage (1). ESPGHAN recommends that patients with mucosal injury be admitted and monitored, and oral diet resumed after an esophagogram with no signs of perforation (2). In children with esophageal-tracheal fistulae, the interval between ingestion of the battery and presentation in the hospital ranges between 1 hour and 3.5 weeks. The diagnosis of the fistula is often subsequent to battery removal (3).

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Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

Cited by 9 publications

References 6 publications

Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

Clinical Presentations, Diagnosis, and Management for Pediatric Antral Web—A 20-Year Experience of a Referral Center

Successful endoscopic treatment of an obstructing gastric antral web in a paediatric patient

Tracheoesophageal Fistula after Button Battery Ingestion

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