Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2017; 9(1): 19-25
Published online Jan 16, 2017. 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, Neha Nigam, Walid M Chalhoub, Dalia I Abdelaziz, James H Lewis, Stanley B Benjamin
Shannon J Morales, Neha Nigam, Walid M Chalhoub, Dalia I Abdelaziz, James H Lewis, Stanley B Benjamin, Division of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
Author contributions: Morales SJ and Nigam N are the co-first authors, and contributed equally to this work; Morales SJ, Nigam N, Abdelaziz DI, Lewis JH and Benjamin SB designed research; Morales SJ, Nigam N, Abdelaziz DI, Lewis JH and Benjamin SB performed research; Morales SJ and Nigam N analyzed data; Morales SJ, Nigam N, Abdelaziz DI, Lewis JH and Benjamin SB wrote the paper; all the authors contributied to the article.
Institutional review board statement: The study was reviewed and approved by the Georgetown University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflicts of interest for any authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Walid M Chalhoub, MD, Division of Gastroenterology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, United States. walid.m.chalhoub@gunet.georgetown.edu
Telephone: +1-202-4447268 Fax: +1-202-4440417
Received: June 14, 2016
Peer-review started: June 16, 2016
First decision: July 20, 2016
Revised: August 18, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: January 16, 2017
Processing time: 203 Days and 3.3 Hours
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: Gastric antral web; Gastric outlet obstruction; Needle knife; Balloon dilation; Triamcinolone injection

Core tip: Gastric antral webs (GAWs) in adults are rare, likely often overlooked, and when seen, considered to be incidental findings on upper endoscopy. They can, however, cause symptoms including gastric outlet obstruction. Herein, we review management of 34 such patients that underwent treatment at our tertiary institution. Our findings indicate that GAWs can be managed safely and effectively via endoscopic intervention with balloon dilation and endoscopic incision with needle knife, although repeat procedures were required in some cases, and a small risk of perforation exists. Standards for appropriate surveillance and appropriate indications for surgical intervention are yet to be defined.