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

Abstract

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.

Keywords: Case report; endoscopic treatment; gastric antral web; gastric outlet obstruction; paediatrics.

Figure 1

(a) Upper gastrointestinal contrast showing delayed gastric emptying, typical ‘double-bulb’ sign. (b) Gastroscopy demonstrating a ‘circumferential stenosis’ about 2–3 cm away from the pylorus. (c) Ultrasound gastroscopy revealing the thickness of the gastric wall and mucosal layer to be about 8.1 mm and 2.6 mm, respectively (empty arrow indicates the gastric wall and solid arrow indicates the mucosal layer)

Figure 2

(a and b) Three electroincisions performed in a radial fashion through the web. (c) The appearance of about a third of the web resected. (d) At 6 months’ endoscopic therapy, gastroscopy showing no circumferential stenosis