A 5-year-old boy presented with intermittent nonbilious vomiting for over 1 year.
During the gastroscopy examination, an antral web with a central aperture was found
with the pylorus visible in the distance ([Fig. 1]). A barium swallow test showed narrowing in the area of antrum and pylorus, but
the contrast agent could still pass through ([Fig. 2]). The definitive diagnosis of “congenital antral web, incomplete antral web” was
made. Endoscopic treatment was subsequently performed ([Fig. 3], [Video 1]). The web was incised directly using an insulated-tipped knife (Olympus, Tokyo,
Japan) in a radial pattern at eleven, three, and seven o'clock until the circular
muscle was completely cut, clearly exposing the antrum and pylorus. The endoscope
was able to pass the pylorus smoothly after the incision. The patient was discharged
in stable condition after 6 days without any adverse events. The patient's symptoms
were significantly resolved and a follow-up endoscopy at 6 months suggested good wound
healing and widened aperture of the residual web ([Fig. 4]).
Fig. 1 Endoscopic view of the antral web (black arrow) and the pylorus (white arrow).
Fig. 2 Barium swallow test showed narrowing in the area of antrum and pylorus (arrow).
Fig. 3 Endoscopic antral web radial incision.
Endoscopic radial incision of a congenital antral web in a child.Video 1
Fig. 4 Endoscopic follow-up showed widened aperture of the residual web.
Antral web is a rare cause of gastric outlet obstruction. Its current treatment is
mostly surgical web excision with pyloroplasty, but this method can be traumatic and
often causes complications like bile reflux. Endoscopic treatment offers advantages
of minimal damage to surrounding tissues and normal anatomy, shorter operation time,
and faster postoperative recovery. There are few reports on endoscopic intervention
for congenital antral web, usually combined with balloon dilation [1]. However, balloon dilation may have to be performed multiple times owing to unsatisfactory
results. Our patient achieved successful results with a simple endoscopic radial incision,
performed only once, with no signs of further narrowing. Endoscopic radial incision
may be a safe and effective method for treating incomplete congenital antral web.
Endoscopy_UCTN_Code_TTT_1AO_2AH
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