Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):351-354. 10.5223/pghn.2018.21.4.351.

Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

• Peck J
• Khalaf R
• Marth R
• Phen C
• Sosa R
• Cordero FB
• Wilsey M

• KMID: 2422000
• DOI: http://doi.org/10.5223/pghn.2018.21.4.351

Abstract

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.

Keyword

Gastric outlet obstruction; Pediatrics; Vomiting; Failure to thrive; Endoscopy

MeSH Terms

Child
Diagnosis
Endoscopy
Failure to Thrive
Female
Gastric Outlet Obstruction
Humans
Infant
Pediatrics
Pyloric Stenosis
Stomach Ulcer
Vomiting

Figure

• 

  Fig. 1 Pre-ablation antral web viewed endoscopically. Gray tissue comprised of hypertrophied mucosa narrowing the lumen of the pylorus. Opening measuring 5 to 6 mm in diameter.

• 

  Fig. 2 Endoscopic view of antral web ablation. Mucosal tearing is evident by gaps within the gray mucosal tissue revealing dark muscular tissue of the pylorus underneath as viewed endoscopically through the balloon. Serial balloon dilatation using controlled radial expansion balloons (CRE; Boston Scientific, Marlborough, MA, USA) were inserted in the pylorus and gradually expanded first to 9 then to 10 mm, and then to 11 and 12 mm, then a third balloon was used to dilate to 13.5 mm and then finally 15 mm, ranging between 1 to 2 minutes at each session (2 minutes for the final two).

• 

  Fig. 3 Antrum post balloon dilation of antral web. Normal pyloric canal and duodenal mucosa posterior to area of dilation.

Reference

1. Noel R, Glock MS, Pranikoff T, Hill ID. Nonobstructive antral web: an unusual cause of excessive crying in an infant. J Pediatr Gastroenterol Nutr. 2000; 31:439–441.

2. Nam S, Koo SH, Chung ML, Jung YJ, Lim YJ. Congenital antral web in premature baby. Pediatr Gastroenterol Hepatol Nutr. 2013; 16:49–52.

3. Lui KW, Wong HF, Wan YL, Hung CF, Ng KK, Tseng JH. Antral web: a rare cause of vomiting in children. Pediatric Surg Int. 2000; 16:424–425.

4. Lu JP, Huang Y, Wu J, Chen SY. Uncommon congenital antral web misdiagnosed twice as pyloric ulcer: successful treatment with endoscopic balloon dilatation. Turk J Pediatr. 2014; 56:100–102.

5. Byun J, Kim HY, Noh SY, Kim SH, Jung SE, Lee SC, et al. Neonatal gastric perforation: a single center experience. World J Gastrointest Surg. 2014; 6:151–155.

6. Ghahremani GG. Nonobstructive mucosal diaphragms or rings of the gastric antrum in adults. Am J Roentgenol Radium Ther Nucl Med. 1974; 121:236–247.

7. Saral W, Baron TH Sr. Gastric antral web: a rare cause of gastric outlet obstruction treated with endoscopic therapy. Gastrointest Endosc. 2013; 78:450.