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. 2017 Jan 16;9(1):19-25.
doi: 10.4253/wjge.v9.i1.19.

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

Shannon J Morales  1 , Neha Nigam  1 , Walid M Chalhoub  1 , Dalia I Abdelaziz  1 , James H Lewis  1 , Stanley B Benjamin  1
Affiliations

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

Shannon J Morales et al. World J Gastrointest Endosc. .

Abstract

Aim: To investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients.

Methods: We 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.

Results: We 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.

Conclusion: Endoscopic 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.

Keywords: Balloon dilation; Gastric antral web; Gastric outlet obstruction; Needle knife; Triamcinolone injection.

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Conflict of interest statement

Conflict-of-interest statement: No conflicts of interest for any authors.

Figures

Figure 1
Figure 1
Endoscopic images from Case 1. A: An obstructing gastric antral web (GAW); B: Balloon dilation of the GAW; C: The appearance of the GAW following balloon dilation; D: A normal pylorus seen distally to the GAW.
Figure 2
Figure 2
Needle-knife incision of a gastric antral web. A: Four-quadrant needle-knife incision of a gastric antral web (GAW); B: The final appearance of a GAW following balloon dilation, four-quadrant needle-knife incision, and triamcinolone injection.
See this image and copyright information in PMC

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