Gastric antral web: a rare cause of gastric outlet obstruction treated with endoscopic therapy

Salah, Wajeeh; Baron, Todd H.

doi:10.1016/j.gie.2013.07.009

Cited by 12 publications

(6 citation statements)

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“…This technique has also proven effective in treating an obstructing duodenal web[9]. In 2013, Salah reported a case of obstructing GAW in an 11 year old boy treated with snare resection, electroincision and balloon dilation[18]. Several cases, including ours, have shown long-term resolution of symptoms after radial incisions using needle-knife electrocautery, but the use of empiric triamcinolone acetate for its anti-inflammatory effects has not been previously reported.…”

Section: Discussionmentioning

confidence: 98%

Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

Morales

Nigam

Chalhoub

et al. 2017

WJGE

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AIMTo investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients.METHODSWe reviewed our endoscopy database seeking to identify patients in whom a GAW was visualized among 24640 esophagogastroduodenoscopies (EGD) over a seven-year period (2006-2013) at a single tertiary care center. The diagnosis of GAW was suspected during EGD if aperture size of the antrum did not vary with peristalsis or if a “double bulb” sign was present on upper gastrointestinal series. Confirmation of the diagnosis was made by demonstrating a normal pylorus distal to the GAW.RESULTSWe identified 34 patients who met our inclusion criteria (incidence 0.14%). Of these, five patients presented with gastric outlet obstruction (GOO), four of whom underwent repeated sequential balloon dilations and/or needle-knife incisions with steroid injection for alleviation of GOO. The other 29 patients were incidentally found to have a non-obstructing GAW. Age at diagnosis ranged from 30-87 years. Non-obstructing GAWs are mostly incidental findings. The most frequently observed symptom prompting endoscopic work-up was refractory gastroesophageal reflux (n = 24, 70.6%) followed by abdominal pain (n = 11, 33.4%), nausea and vomiting (n = 9, 26.5%), dysphagia (n = 6, 17.6%), unexplained weight loss, (n = 4, 11.8%), early satiety (n = 4, 11.8%), and melena of unclear etiology (n = 3, 8.82%). Four of five GOO patients were treated with balloon dilation (n = 4), four-quadrant needle-knife incision (n = 3), and triamcinolone injection (n = 2). Three of these patients required repeat intervention. One patient had a significant complication of perforation after needle-knife incision.CONCLUSIONEndoscopic intervention for GAW using balloon dilation or needle-knife incision is generally safe and effective in relieving symptoms, however repeat treatment may be needed and a risk of perforation exists with thermal therapies.

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Section: Discussionmentioning

confidence: 98%

Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

Morales

Nigam

Chalhoub

et al. 2017

WJGE

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“…In addition, Salah and Baron suggested that endoscopic treatment for GAW can be used as first-line treatment in selected patients. [ 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.…”

Section: Discussionmentioning

confidence: 99%

“…[ 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. [ 5 7 8 ]…”

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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“…There are, however, limitations to using endoscopic balloon dilation. While endoscopic balloon dilation is considered a less invasive and viable option in most patients [ 7 ], surgical resection remains an important alternative, especially with special anatomic considerations such as an uneven or non-perpendicular mucosal layer or the involvement of vascular structures or muscular layers [ 2 ]. Surgery is also a safer alternative in premature infants, particularly those weighing less than 2 kg [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

Peck

Khalaf

Marth

et al. 2018

Pediatr Gastroenterol Hepatol Nutr

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Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web. The web was successfully treated with endoscopic balloon dilation, which resolved her symptoms. Two years later, the patient remains asymptomatic and is thriving with weight at the 75th percentile for her age.

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Gastric antral web: a rare cause of gastric outlet obstruction treated with endoscopic therapy

Cited by 12 publications

References 0 publications

Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

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

Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

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