Treatment of Congenital Gastric Outlet Obstruction due to a Web: A Retrospective Single-center Review

Abstract

Background: Congenital gastric antral web and congenital pyloric atresia are rare reasons of congenital gastric outlet obstruction (CGOO). Depending on the different forms, the symptoms vary from unspecific epigastric pain to nonbilious "projectile" vomiting, ileus and failure to thrive. Throughout the years, many different treatment options are described, like simple surgical dilatation, incision or excision of the membrane, possibly combined with a pyloroplasty.Patients and Methods: In this retrospective single-center observation study, we present 9 cases with different kinds of webs leading to CGOO. In a time period of 45 years (1970 to 2015) different treatment strategies and limitations of minimal invasive endoscopic treatment on the basis of complications and outcome are discussed.Results: Six patients had an incomplete antrum web. One patient suffered from a complete antrum web. In addition, in 2 patients a complete pyloric web, as well as an incomplete pyloric web was found. During the past 45 years, the treatment options for CGOO due to webs changed, and with the development of smaller and more flexible video endoscopes an endoscopic treatment has become feasible. The treatment strategy and follow-up examination was specific to every patient. Conclusion:On the basis of our review, minimal endoscopic procedures in small newborns and toddlers require a high level of experience. They are technically challenging and need suitable equipment. Overall, endoscopists and pediatric surgeons should equally be prepared for all possible complications in every treatment step. The endoscopic approach to managing this unusual disease may require multiple interventions and is associated with a risk of perforation. Therefore, we are convinced that centers undertaking this treatment modality should be equipped with the proper instrumentation, prepared to perform multiple endoscopic interventions, and supported with an ability to emergently convert to surgery if required.

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

“…Six pediatric series in the English literature containing 78 cases were retrieved and compared ( 1 , 3 , 5 , 6 , 8 , 9 ) ( Table 4 ). In addition to the gender and diagnostic age, the onset-to-diagnosis and modalities of intervention were denoted.…”

“…The diagnosis can be challenging, given the non-specific symptoms and relatively insufficient awareness of this etiology ( 3 ). The inconsistency of episodic presentations and misinterpretation of the image may also puzzle the physicians ( 3 ). Partial obstruction may lead to a prolonged diagnostic process and inefficacious treatment ( 5 ).…”

“…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 ).…”

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 ]…”

Pyloric Mucosal Diaphragm Associated with Hypertrophic Pyloric Stenosis: An Unusual Combination in a Male Neonate

“…High level of experience and suitable equipment is required. 10 Intraoperatively, it is important to exclude the presence of multiple diaphragms or atresias.…”