Endoscopic Balloon Dilation for Treatment of Congenital Antral Web

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.

Keywords: Endoscopy; Failure to thrive; Gastric outlet obstruction; Pediatrics; Vomiting.

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.