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Diagnosis and treatment of gastric antral webs in pediatric patients

  • Ruchi Amin
  • Alfonso M. Martinez
  • Marjorie J. Arca
Article
  • 22 Downloads

Abstract

Background

Gastric antral webs are mucosal structures, varying from fenestrated diaphragms to mucosal crescents, resulting in varying degrees of foregut obstruction. Patients commonly present with vomiting, failure to thrive, and abdominal pain. Prevalence is unknown, and diagnosis can be difficult.

Methods

We performed an IRB-approved retrospective review of patients from 4/1/2015–4/1/2018 at a Level I Children’s Surgery Center undergoing gastric antral web resection. Data obtained included demographics, preoperative workup, surgical repair, and outcomes.

Results

Twenty-one patients were identified; 67% were male with an average age of 30 months at diagnosis. Initial diagnosis was established by a combination of fluoroscopy and esophagogastroduodenoscopy (EGD) in all patients. Patients presented with emesis (76%), failure to thrive (57%), need for post-pyloric tube feeds (33%), and abdominal pain (14%). Web localization without intraoperative EGD (n = 3) was initially challenging. As a result, intraoperative EGD was combined with operative antral web resection to facilitate web localization (n = 18). Web marking techniques have evolved from marking with suture (n = 1) and tattoo (n = 2), to endoscopic clip application (n = 12). All 21 patients underwent web resection, 2 were performed laparoscopically. Twenty underwent Heineke-Mikulicz pyloroplasty during the initial surgery. Average length of stay was 5.5 days. There were no intraoperative complications or deaths. Permanent symptom resolution occurred in 90% of patients immediately, with a statistically significant decrease in emesis (p < 0.001), failure to thrive (p < 0.001), and need for post-pyloric tube feeding (p = 0.009) within 6 months of surgery.

Conclusion

Gastric antral webs should be considered in the differential diagnosis for a child with persistent vomiting. Web resection with the use of intraoperative endoscopic localization can result in permanent symptom resolution in the majority of these patients.

Keywords

Gastric antral web Endoscopy Heineke-Mikulicz pyloroplasty 

Notes

Author contributions

All authors made substantial contributions to the design, analysis, and interpretation of data for the work. All authors worked on drafting or revising the manuscript, and gave final approval of the version to be published. All authors are accountable for the work with regard to its accuracy and integrity.

Compliance with ethical standards

Disclosures

Dr. Amin, Dr. Martinez, and Dr. Arca have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Children’s Hospital of Wisconsin and Division of Pediatric Surgery, Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  2. 2.Children’s Hospital of Wisconsin and Division of Pediatric Gastroenterology, Department of GastroenterologyMedical College of WisconsinMilwaukeeUSA

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