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

Abstract

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.

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

“…[ 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 ]…”

Gastric Antral Webs: Anatomical Variants and Appropriate Endotherapy

“…GAW or antral mucosal diaphragm is a rare lesion reported in all ages, with an incidence of 0.14% in adults. 1,2 It consists of a layer of mucosa and submucosa lying perpendicular to the long axis of the stomach conjectured to occur during the healing of circumferential prepyloric ulcers.…”

“…Though the absence of muscularis propria in GAW makes complications less likely, endotherapy should be performed cautiously. 2…”