Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3622
Revised: April 23, 2024
Accepted: May 14, 2024
Published online: June 26, 2024
Processing time: 92 Days and 3.6 Hours
Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea, vomiting, and postprandial fullness. The treatment for this disease is mostly surgical. Endoscopic treatment techniques have been developed and attempted for this disease. Endoscopic radial incision and cutting (RIC) techniques are reportedly very effective in benign anastomotic stricture. This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.
A 23-year-old female patient with indigestion was referred to a tertiary hospital. The patient complained of postprandial fullness in the epigastric region. Previous physical examinations or blood tests indicated no abnormalities. Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum. Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb; a very small hole was observed in the distal part of the second portion, and scope passage was not possible. Gastrografin upper gastrointestinal series was performed, revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim, a typical "windsock" sign. Endoscopic RIC was performed on the duodenal web. The patient recovered uneventfully. Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis. The patient reported complete resolution of symptoms at the 18-month follow-up.
Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.
Core Tip: The treatment of duodenal webs has evolved with medical advancements, particularly in endoscopy, shifting from traditional surgical management to minimally invasive endoscopic approaches. Recent advances in endoscopic instruments and techniques have rendered endoscopic treatment a viable alternative. Generally, endoscopic balloon dilatation requires multiple sessions rather than a single treatment. Endoscopic membranectomy or incisional therapy may ultimately necessitate surgical intervention for restenosis owing to scarring. By contrast, radial incision and cutting is a safe, rapid, and effective treatment method that allows complete circumferential excision of the web. Unlike surgery, it does not require a prolonged hospital stay and presents a very low risk of surgical complications, making it an effective alternative treatment.