Gastric Antral Web Research Articles

Gastric antral web presenting with esophageal stricture and severe malnutrition

Gastric antral web is a rare cause of gastric outlet obstruction in children. Common complaints include intermittent non-bilious vomiting, bloating, pain, loss of appetite, and weight loss. Herein, we report a case of gastric antral web presenting with esophageal stricture and malnutrition, which was followed for many years with a misdiagnosis. An 8-year-old African boy was referred to our pediatric gastroenterology clinic due to recurrent vomiting and severe malnutrition. According to his medical history, the patient began experiencing non-bilious vomiting at 40 days of age and a diagnosis of gastroesophageal reflux was made. He was hospitalized multiple times and received nasogastric tube feedings in the following 4 years. He was re-evaluated for growth retardation and malnutrition at 4 years of age. He had been diagnosed with gluten enteropathy and was fed a gluten-free diet. Recently, he developed difficulty swallowing solid food and was only able to consume liquid meals. Esophagography revealed segmental stenosis in the distal portion of the esophagus. After stricture excision with thoracotomy, upper gastrointestinal series with a radiopaque substance indicated normal esophageal passage; however, prolonged gastric emptying time was also noted. Upon examination during laparotomy, a congenital web was detected in the antral region and was excised. Esophageal and gastric pathologies were consistent with stricture caused by reflux esophagitis and gastric antral web. Today, gastric antral web is mostly diagnosed and treated in infancy. Near total obstruction is relatively easy to diagnose; however, many patients with partial obstruction are followed-up for years with an incorrect diagnosis. Therefore, it should be considered in such cases, persistent vomiting and gastroesophageal reflux may be associated with esophageal stricture.

Electrosurgical incision is safe and effective for the definitive treatment of gastric antral webs during endoscopic balloon dilatation in children

Background: Congenital gastric antral web is a rare cause of gastric outlet obstruction in children. Treatment options have evolved from the traditional surgical approach to endoscopic balloon dilatation (EBD). The authors would like to share their experience in using minimal invasive endoscopic techniques in the treatment of pediatric gastric antral webs.Materials and Methods: This is a retrospective study between 2015 and 2019. Data obtained included patient demographics, symptoms, image studies, endoscopic treatment, postoperative feeding, length of hospital stay, and outcome.Results: A total of four patients with gastric antral web who received electrosurgical incision (ESI) and EBD were enrolled. The median age was 12.5 months old (range 2–30 months). Recurrent vomiting was the most frequent symptom. The diagnosis was confirmed by upper gastrointestinal series and esophagogastroduodenoscopy. All patients underwent a combined procedure: endoscopic ESI of the web followed by EBD. The median duration of the procedure was 85 min. The median postoperative feeding started at 2.6 h. The median length of hospital stay after the procedure was 1.5 days. The median follow-up was 24 months. There were no recurrences or redo procedures. Follow-up of each patient was all symptom-free with adequate weight gain. The success rate was 100%.Conclusion: The use of ESI in combination with EBD is safe and effective for the definitive treatment of gastric antral webs in infants and children. With available expertise, it can be used safely as the first-line treatment. With the addition of ESI, it is associated with low recurrence rate and a faster recovery.

Gastric antral web

Gastric antral web is a rare cause of gastric outlet obstruction with an incidence of 1 in 100,00 births. Only about 150 cases have been reported. Antral web is a thin fenestrated diaphragm made up of 2 layers of mucosa and usually lacking muscular component. Evidence of it being both of congenital or acquired cause has been reported, but the theory of localized endodermal proliferation during developmental stage is the most accepted. The most common presentation is of non-bilious vomiting and often diagnosed in infancy however diagnosis can be delayed due to non obstructive nature of symptoms. It is often misdiagnosed as infantile hypertrophic pyloric stenosis or pylorospasm. It can be confirmed with Barium enhanced radiographs of upper GIT, ultrasound and endoscopy. The non symptomatic antral web can be advised supportive measures but in the symptomatic group surgery is the treatment of choice. Antral web excision with or without pyloroplasty is done. It has good prognosis. • Gastric antral web is a rare cause of gastric outlet obstruction with an incidence of 1 in 100,00 births. • It most commonly presents as non-bilious vomiting and often diagnosed in infancy however its diagnosis can be delayed due to non-obstructive nature of symptoms. • It is often misdiagnosed as infantile hypertrophic pyloric stenosis. • It can be confirmed with Barium enhanced radiographs of upper GIT, ultrasound and endoscopy.

Successful endoscopic treatment of an obstructing gastric antral web in a paediatric patient: A case report.

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.

Gastric Antral Webs: Anatomical Variants and Appropriate Endotherapy

AbstractWe report the case of a 65-year-old patient with rheumatoid arthritis presenting with dyspeptic symptoms. Upper gastrointestinal (UGI) endoscopy revealed a gastric antral web, which was confirmed by UGI series. The presence of webs in the gastrointestinal tract, excluding the esophagus, is a rarity. Here, we highlight the anatomical variations in antral webs and endoscopic diagnosis, which ultimately influence the type of endotherapy.

Diagnosis and treatment of gastric antral webs in pediatric patients.

Gastric antral webs are mucosal structures, varying from fenestrated diaphragms to mucosal crescents, resulting in varying degrees of foregut obstruction. Patients commonly present with vomiting, failure to thrive, and abdominal pain. Prevalence is unknown, and diagnosis can be difficult. We performed an IRB-approved retrospective review of patients from 4/1/2015-4/1/2018at a Level I Children's Surgery Center undergoing gastric antral web resection. Data obtained included demographics, preoperative workup, surgical repair, and outcomes. Twenty-one patients were identified; 67% were male with an average age of 30months at diagnosis. Initial diagnosis was established by a combination of fluoroscopy and esophagogastroduodenoscopy (EGD) in all patients. Patients presented with emesis (76%), failure to thrive (57%), need for post-pyloric tube feeds (33%), and abdominal pain (14%). Web localization without intraoperative EGD (n = 3) was initially challenging. As a result, intraoperative EGD was combined with operative antral web resection to facilitate web localization (n = 18). Web marking techniques have evolved from marking with suture (n = 1) and tattoo (n = 2), to endoscopic clip application (n = 12). All 21 patients underwent web resection, 2 were performed laparoscopically. Twenty underwent Heineke-Mikulicz pyloroplasty during the initial surgery. Average length of stay was 5.5days. There were no intraoperative complications or deaths. Permanent symptom resolution occurred in 90% of patients immediately, with a statistically significant decrease in emesis (p < 0.001), failure to thrive (p < 0.001), and need for post-pyloric tube feeding (p = 0.009) within 6months of surgery. Gastric antral webs should be considered in the differential diagnosis for a child with persistent vomiting. Web resection with the use of intraoperative endoscopic localization can result in permanent symptom resolution in the majority of these patients.

Gastric diverticulum causing gastric outlet obstruction in the setting of duodenal atresia

Abstract Duodenal obstruction due to duodenal atresia occurs in 1 in 10,000 live births and is the most common type of intestinal obstruction in neonates [1–3]. Gastric outlet obstruction in the newborn period from causes other than hypertrophic pyloric stenosis is very uncommon [3]. Potential etiologies include gastric volvulus, antral web, and duplication cysts. Gastric diverticula in the infant is even more rare, with only a few case reports published, and only one describes a gastric diverticulum in the presence of a duodenal atresia [4–8]. In this report, we describe the first case of a gastric outlet obstruction due to a gastric diverticulum in the presence of duodenal atresia.

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

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.

Gastric Antral Web: A Case Series to Better Define a Rare Cause of Gastric Outlet Obstruction

Introduction: Gastric antral web (AW), or antral diaphragm, is a rare cause of gastric outlet obstruction (GOO). Etiology may be congenital or acquired from ulceration. We identified 33 patients with AW during 24,646 esophagogastroduodenoscopies (EGD) over a 7-year period (2006 to 2013). Only 4 cases (0.02%) presented with symptoms of GOO. Case 1: An 80-year-old female with dysphagia to solids and liquids and persistent vomiting underwent EGD with dilation of presumed pyloric stenosis without relief. Repeat EGD showed an obstructing AW. Sequential balloon dilation allowed passage of a 9.8 mm scope. Symptoms recurred in 2 weeks and the web was incised with needle-knife (NK). Case 2: A 72-year-old male with diabetes underwent EGD for a 10-year history of early satiety, intermittent regurgitation, and 100 lbs weight loss. Prior EGD with biopsy of antral “narrowing” was complicated by bleeding, but repeat showed an obstructing AW precluding passage of a 9-mm scope. Sequential balloon dilation from 8-15 mm was performed, allowing a 5 lbs weight gain in 2 weeks. Case 3: A 60-year-old female with dysphagia and nausea had an obstructing AW on EGD. Balloon dilation, 4-quadrant NK cuts, and steroid injection were performed without resolution of symptoms. Over a 5-year period, she underwent similar interventions with incremental improvement. Surgery was not offered. Case 4: A 74-year-old female with arthritis was admitted for 6 weeks of 10 loose, intermittently melenic, stools daily. Thickened antrum and pancolitis were noted on endoscopy. EGD performed after a 3-week steroid course showed an AW requiring a 6 mm scope to traverse. As per patient wishes, no intervention was performed. Cases 5 to 33: Twenty-nine patients were incidentally found to have a non-obstructing AW during EGD. Seventeen patients underwent EGD for gastroesophageal reflux not alleviated with long-term protonpump inhibitor use or presence of dysphagia, odynophagia, weight loss, or anemia. Twelve individuals were scoped for chronic abdominal pain, 2 of whom had melena of unclear etiology. Discussion: Non-obstructing AWs are incidental findings and frequently asymptomatic. Diagnosis is usually suspected during EGD, in which aperture size does not vary with peristalsis or ‘double bulb’ sign on upper GI series. Confirmation is made by demonstrating a normal pylorus distal to the AW. Symptoms of GOO are common with web aperture less than 1 cm. However, the association between GI bleeding when no other etiology is identified and reflux symptoms needs further study. Endoscopic balloon dilation is transiently effective. Endoscopic incision can be effective and safe in relieving symptoms, but repeat treatment may be needed. The role of surgery needs to be better defined.

Antral Web Causing Gastric Outlet Obstruction: Endoscopic Diagnosis and Management Options

Purpose: Gastric antral web, or antral diaphragm, is a rare cause of gastric outlet obstruction. Management includes surgery and endoscopic incision of the web. We present two cases to increase clinical awareness of this entity. Case 1: An 80-year-old female with a history of hypertension, breast, and lung cancer presented with dysphagia, nausea and vomiting, increased reflux and abdominal fullness. Upper endoscopy showed distal gastric obstruction presumed to be pyloric stenosis. Despite dilation, symptoms returned within weeks. CT showed no evidence of external compression at the pylorus. Repeat endoscopy revealed retained food and an obstructing antral web. Sequential balloon dilation allowed the 9.8 mm endoscope to be advanced without resistance. The pylorus, identified downstream was patent and the duodenum was normal. Given partial return of symptoms within two weeks, endoscopy was repeated and the antral web was incised with a needle knife. Repeat endoscopy for recurrent nausea week later demonstrated an open web. Case 2: A 72-year-old with a history of CAD, diabetes, and gout presents with recurrent vomiting and early satiety. He has a ten-year history of intermittent food regurgitation with weight loss from 220 pounds to 130 pounds. He had an upper GI series, which showed a narrowing at the antrum. Prior outside upper endoscopy and biopsy of “narrowing” was complicated with UGI bleeding. Repeat upper endoscopy revealed an obstructing antral web. A 6-mm endoscope was passed through the web without resistance. Sequential balloon dilation over a guidewire from 8 to 15 mm was performed, and allowed a 9-mm scope to pass through the web easily. The prepyloric antrum and pylorus appeared normal. Patient continues to do well three months post procedure. He is tolerating a regular diet without difficulty and has gained five pounds. Antral web may be congenital or acquired and are a rare cause for gastric outlet obstruction. Gastric outlet obstruction is associated with an opening size less than 1 cm. The theory asserts that peptic ulcers cause circumferential scarring and web formation; the likely etiology in our patients. The congenital webs are presumed to be the result of focal tissue ischemia. Diagnosis is usually made via UGI or endoscopy. On UGI, a ‘double bulb' sign can be seen. On endoscopy, antral webs should be distinguished from the pylorus by the presence of the real pylorus downstream. In the symptomatic patient, endoscopic management should be attempted first. Balloon dilation or endoscopic incision appear to be safe. Although rare, clinicians must be cognizant of antral web as a possible etiology for gastric outlet obstruction.

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

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

Sp708 Endoscopic Therapy of a Gastric Antral Web Causing Gastric Outlet Obstruction

Gastric antral web (GAW) is a rare cause of gastric-outlet obstruction in both children and adults. An 11 y/o boy referred to our institution for evaluation of nausea, abdominal pain and failure to thrive. He carried a diagnosis of “narrowed pylorus” by an outside facility and had undergone multiple EGDs with pyloric balloon dilation and pyloric botulinum toxin injections. This improved his symptoms for a few weeks, and then the nausea and pain returned. An upper GI series revealed a thin band-like deformity of the distal gastric antrum suggestive of an incomplete antral web. Surgical consultation recommended antrotomy and pyloroplasty. The patient came to our institutionfor an additional opinion regarding non-surgical therapy. An upper endoscopy was performed and confirmed the diagnosis of an antral web with 3 obstructing rings. A diagnostic upper endoscope could not be passed through the rings. Using a standard biliary needle-knife and electrocautery, multiple electroincisions were performed in a radial fashion through all points of obstruction in all 3 rings. A snare was used to resect some of the web as well after the electroincision. The endoscope was then passed to the second duodenum, and a 20-mm dilating balloon was passed through the channel of the endoscope. The endoscope was withdrawn and positioned with the balloon across the distal antrum and pylorus. The balloon was inflated to 20 mm. This exposed the more muscular part of the ring which was subsequently electroincised, and redilation with to 20 mm was performed. A therapeutic adult upper endoscope could be easily passed at the end of the procedure through the antrum and pylorus. The patient's symptoms resolved post endoscopic therapy and a follow-up upper GI was obtained after four weeks which showed a normal antrum. At 3 months, patient continued to have resolution of his symptoms, was eating well and gaining weight. This case illustrates the value of upper GI series and endoscopy establishing a correct diagnosis of gastric antral web. This case highlights that endoscopic therapy for a gastric antral web can be used as a first line treatment modality in selected patients. It also shows that endoscopic therapy can be used to avoid a potentially invasive surgical procedure and provide long-lasting resolution of symptoms in appropriate patients.

Gastric Antral Web in a 103-Year-Old Patient

Gastric antral web, also called antral diaphragm, is a rare cause of gastric-outlet obstruction. First described by Touroff et al. in 1940 [1], gastric antral web (GAW) or gastric antral diaphragm is a relatively rare and controversial entity. Both congenital and acquired etiologies have been postulated for this lesion in adults. The congenital theory recognizes that GAW occurs in infants and children. During the second month of embryologic development, the lumen of the developing digestive tract is plugged by a rapid overgrowth of epithelial cells. Vacuoles subsequently appear in the plugs and eventually coalesce to reestablish gut patency. The proposed mechanism for GAW is the failure of vacuoles to coalesce in the stomach [2]. However, acquired antral web in adults due to peptic diseases has also been documented [1, 3]. Approximately-one-quarter of all reported cases of GAW has been associated with either gastric or duodenal ulcer disease. Acquired etiology may be caused by scarring of the linear circumferential prepyloric and pyloric ulcers [4].

Infantile myofibromatosis: a most unusual cause of gastric outlet obstruction

Non-bilious vomiting in the newborn is common. Etiologies include both surgical and medical conditions. Gastroesophageal reflux, soy or milk protein allergy, and prostaglandin-induced foveolar hyperplasia are among the medical causes. Surgical entities include gastric antral webs, pre-ampullary duodenal and pyloric atresia, and hypertrophic pyloric stenosis. We report the unique case of an 8-day-old girl who presented with gastric outlet obstruction secondary to infantile myofibromatosis.

Duodenal atresia and gastric antral web. A significant lesion to learn

Duodenal atresia and gastric antral web. A significant lesion to learn

Gastric Antral Webs in Adults

A case of a gastric antral web is described. The possible aetiologies and clinical consequences are discussed.

Prepyloric gastric antral web: A puzzling epidemic

Antral webs and diaphragms are considered a rare cause of gastric outlet obstruction in infants and children. A radiographic diagnosis of antral web was made in 28 children during a 26-mo period. Nonbilious, often projectile vomiting was the predominant presenting symptom in 24 infants who were less than 6 mo of age. The older children complained of pain, vomiting, fullness after eating, and eructation. The characteristic radiologic finging was a wirelike transverse septum 1--2 cm proximal to the pylorus. Poor antral filling was an important early clue in the radiographic search for the webs. Pyloroplasty was performed in 20 patients, frequently after failure of medical management of symptoms. Coexistent congenital abnormalities were present in 28% of patients. A search for environmental and familial factors has failed to elucidate any teratogenic influences in this population.