Electrosurgical incision is safe and effective for the definitive treatment of gastric antral webs during endoscopic balloon dilatation in children

Abstract

Background: Congenital gastric antral web is a rare cause of gastric outlet obstruction in children. Treatment options have evolved from the traditional surgical approach to endoscopic balloon dilatation (EBD). The authors would like to share their experience in using minimal invasive endoscopic techniques in the treatment of pediatric gastric antral webs. Materials and Methods: This is a retrospective study between 2015 and 2019. Data obtained included patient demographics, symptoms, image studies, endoscopic treatment, postoperative feeding, length of hospital stay, and outcome. Results: A total of four patients with gastric antral web who received electrosurgical incision (ESI) and EBD were enrolled. The median age was 12.5 months old (range 2–30 months). Recurrent vomiting was the most frequent symptom. The diagnosis was confirmed by upper gastrointestinal series and esophagogastroduodenoscopy. All patients underwent a combined procedure: endoscopic ESI of the web followed by EBD. The median duration of the procedure was 85 min. The median postoperative feeding started at 2.6 h. The median length of hospital stay after the procedure was 1.5 days. The median follow-up was 24 months. There were no recurrences or redo procedures. Follow-up of each patient was all symptom-free with adequate weight gain. The success rate was 100%. Conclusion: The use of ESI in combination with EBD is safe and effective for the definitive treatment of gastric antral webs in infants and children. With available expertise, it can be used safely as the first-line treatment. With the addition of ESI, it is associated with low recurrence rate and a faster recovery.

Keywords

• balloon dilatation
• electrosurgical incision
• gastric antral web
• gastric outlet obstruction
• needle knife