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Trupti Gundawar - One of the best experts on this subject based on the ideXlab platform.

  • Gastric outlet obstruction secondary to adult gastric Antral Web.
    Annals of gastroenterology, 2013
    Co-Authors: Rachel M. Gomes, Jayesh Kudchadkar, Harish Peshwe, Trupti Gundawar
    Abstract:

    The gastric Antral mucosal diaphragms also called gastric Antral Webs (GAW) are circumferential membranes of mucosa and submucosa with a central aperture that occur in the gastric antrum near the pyloric canal [1]. They form a rare cause of gastric outlet obstruction (GOO) in adults [2,3]. A 45-year-old well-nourished male presented with post-prandial epigastric pain, bloating, fullness and belching since childhood. He had borborygmi and crampy pain postprandially for several hours after which fullness and pain was relieved. He reported intermittent exarcerbations with repeated vomiting containing undigested food taken several days before with recent increase in frequency of episodes. He had undergone an endoscopy a year back reporting a prepyloric ulcer with pyloric stenosis and was treated conservatively with not much improvement. An endoscopy revealed GOO with a very small opening of the pylorus, not negotiable with the scope (Fig. 1). A contrast-enhanced computed tomography demonstrated normal but overdistended stomach, showing abrupt cutoff just proximal to pylorus, with normal caliber pylorus and duodenum without any lesion or thickening but showed some contrast indicating incomplete obstruction (Fig. 2). A diagnosis of pyloric obstruction secondary to healed prepyloric ulcer was made. At laparotomy there was no scarring of antrum, pylorus or duodenum. On pyloroduodenotomy the obstruction was found to be because of a GAW immediately juxtapyloric in position. After dividing the Web, a pyloroplasty was completed. Post surgery patient's symptoms resolved with normal imaging. Figure 1 (A,B) Endoscopic gastroduodenoscopy showing gastric outlet obstruction with a very small opening in the antrum with scope not negotiable across (pinpoint pseudopylorus appearance) Figure 2 (A,B,C) Horizontal and coronal sections of computed tomography scan showing normal but overdistended stomach with retained contrast with abrupt cutoff just proximal to pylorus. Pylorus and duodenum are of normal calibre without any lesion or thickening ... The etiology of GAWs is agreed to be congenital in infants and children whereas in adults, whether it is congenital or acquired is controversial [4]. Approximately one fourth of all reported cases is associated with either gastric or duodenal ulcer disease, possibly caused by scarring of linear circumferential prepyloric and pyloric ulcers [4,5]. Infants and children present with persistent postprandial non bile-stained vomiting and failure to thrive or malnutrition [3]. Adults present with postprandial fullness, bloating, epigastric pain, eructation of foul gas, symptomatically relieved by vomiting. Late presentations in adults are possibly due to progressive narrowing of aperture following marginal ulcerations and decreased motility with time or sudden obstruction secondary to poorly masticated food or mucosal edema of gastritis [6]. A classic feature on barium is a double-bulb appearance: normal duodenal bulb with a proximal Antral chamber between the Web and the pylorus [6]. However, if the Antral chamber is small with close proximity of the Web to the pylorus, as in our case, this sign may not be demonstrated. Whenever the stomach is normal but with gastric retention with an abrupt cutoff, and the pylorus and duodenal cap are normal, a GAW should be considered. EGD usually shows a large mucosal fold with a variable aperture or a pinpoint pseudopylorus as in our case causing diagnostic confusion [5,7]. If GAW aperture is more than one centimeter and the patient is asymptomatic, only dietary modifications are advised [4-6]. In symptomatic patients or in smaller aperture, either surgical or endoscopic intervention is needed. Surgical options are incision of the Web with or without pyloroplasty [5-7]. Endoscopic options are resection with a snare, papillotomy, or Nd:YAG laser [7].

Yun-jung Lim - One of the best experts on this subject based on the ideXlab platform.

  • PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY & NUTRITION Congenital Antral Web in Premature Baby
    2016
    Co-Authors: So-hyun Nam, Soo Hyun Koo, Mi Lim Chung, Yu Jin Jung, Yun-jung Lim
    Abstract:

    Antral Web is a rare cause of gastric outlet obstruction in neonate. It is a 2-4 mm thin mucous membrane that can be found anywhere from 1 to 7 cm proximal to the pylorus. The baby was born at gestational age of 32+1 weeks with 1,880 g as 2nd baby of dizygotic twin. After birth, the baby had constant non-bilious vomiting without feeding while he didn’t show abdominal distension or discoloration. The infantogram showed distended stomach with distal small bowel gas. Upper gastrointestinal series revealed that the antrum was abruptly narrowed at 1 cm proximal to pylorus. We performed laparotomy at the 10th day after birth and excised the 2 mm-thick Web circumferentially. He began milk feeding after 6 days and discharged uneventfully at postoperative 35 days with corrected age of 38+4 weeks with body weight 2,420 g. The Antral Web should be considered in the case of non-bilious vomiting in neonate. (Pediat

  • Congenital Antral Web in Premature Baby
    Pediatric gastroenterology hepatology & nutrition, 2013
    Co-Authors: So-hyun Nam, Soo Hyun Koo, Mi Lim Chung, Yu Jin Jung, Yun-jung Lim
    Abstract:

    Antral Web is a rare cause of gastric outlet obstruction in neonate. It is a 2-4 mm thin mucous membrane that can be found anywhere from 1 to 7 cm proximal to the pylorus. The baby was born at gestational age of 32+1 weeks with 1,880 g as 2nd baby of dizygotic twin. After birth, the baby had constant non-bilious vomiting without feeding while he didn't show abdominal distension or discoloration. The infantogram showed distended stomach with distal small bowel gas. Upper gastrointestinal series revealed that the antrum was abruptly narrowed at 1 cm proximal to pylorus. We performed laparotomy at the 10th day after birth and excised the 2 mm-thick Web circumferentially. He began milk feeding after 6 days and discharged uneventfully at postoperative 35 days with corrected age of 38+4 weeks with body weight 2,420 g. The Antral Web should be considered in the case of non-bilious vomiting in neonate.

Rachel M. Gomes - One of the best experts on this subject based on the ideXlab platform.

  • Gastric outlet obstruction secondary to adult gastric Antral Web.
    Annals of gastroenterology, 2013
    Co-Authors: Rachel M. Gomes, Jayesh Kudchadkar, Harish Peshwe, Trupti Gundawar
    Abstract:

    The gastric Antral mucosal diaphragms also called gastric Antral Webs (GAW) are circumferential membranes of mucosa and submucosa with a central aperture that occur in the gastric antrum near the pyloric canal [1]. They form a rare cause of gastric outlet obstruction (GOO) in adults [2,3]. A 45-year-old well-nourished male presented with post-prandial epigastric pain, bloating, fullness and belching since childhood. He had borborygmi and crampy pain postprandially for several hours after which fullness and pain was relieved. He reported intermittent exarcerbations with repeated vomiting containing undigested food taken several days before with recent increase in frequency of episodes. He had undergone an endoscopy a year back reporting a prepyloric ulcer with pyloric stenosis and was treated conservatively with not much improvement. An endoscopy revealed GOO with a very small opening of the pylorus, not negotiable with the scope (Fig. 1). A contrast-enhanced computed tomography demonstrated normal but overdistended stomach, showing abrupt cutoff just proximal to pylorus, with normal caliber pylorus and duodenum without any lesion or thickening but showed some contrast indicating incomplete obstruction (Fig. 2). A diagnosis of pyloric obstruction secondary to healed prepyloric ulcer was made. At laparotomy there was no scarring of antrum, pylorus or duodenum. On pyloroduodenotomy the obstruction was found to be because of a GAW immediately juxtapyloric in position. After dividing the Web, a pyloroplasty was completed. Post surgery patient's symptoms resolved with normal imaging. Figure 1 (A,B) Endoscopic gastroduodenoscopy showing gastric outlet obstruction with a very small opening in the antrum with scope not negotiable across (pinpoint pseudopylorus appearance) Figure 2 (A,B,C) Horizontal and coronal sections of computed tomography scan showing normal but overdistended stomach with retained contrast with abrupt cutoff just proximal to pylorus. Pylorus and duodenum are of normal calibre without any lesion or thickening ... The etiology of GAWs is agreed to be congenital in infants and children whereas in adults, whether it is congenital or acquired is controversial [4]. Approximately one fourth of all reported cases is associated with either gastric or duodenal ulcer disease, possibly caused by scarring of linear circumferential prepyloric and pyloric ulcers [4,5]. Infants and children present with persistent postprandial non bile-stained vomiting and failure to thrive or malnutrition [3]. Adults present with postprandial fullness, bloating, epigastric pain, eructation of foul gas, symptomatically relieved by vomiting. Late presentations in adults are possibly due to progressive narrowing of aperture following marginal ulcerations and decreased motility with time or sudden obstruction secondary to poorly masticated food or mucosal edema of gastritis [6]. A classic feature on barium is a double-bulb appearance: normal duodenal bulb with a proximal Antral chamber between the Web and the pylorus [6]. However, if the Antral chamber is small with close proximity of the Web to the pylorus, as in our case, this sign may not be demonstrated. Whenever the stomach is normal but with gastric retention with an abrupt cutoff, and the pylorus and duodenal cap are normal, a GAW should be considered. EGD usually shows a large mucosal fold with a variable aperture or a pinpoint pseudopylorus as in our case causing diagnostic confusion [5,7]. If GAW aperture is more than one centimeter and the patient is asymptomatic, only dietary modifications are advised [4-6]. In symptomatic patients or in smaller aperture, either surgical or endoscopic intervention is needed. Surgical options are incision of the Web with or without pyloroplasty [5-7]. Endoscopic options are resection with a snare, papillotomy, or Nd:YAG laser [7].

Altun Reskan - One of the best experts on this subject based on the ideXlab platform.

  • A non-obstructive gastric Antral Web case detected after upper gastrointestinal system bleeding
    'AVES Publishing Co.', 2019
    Co-Authors: Akbaş Enver, Altun Reskan
    Abstract:

    This is the first study on the construction of the relation-ship between a non-obstructive gastric Antral Web and gastric-outlet obstruction in children and adults.Congenital or acquired gastric Antral Webs (GAWs) may cause gastric-outlet obstruction in children and adults. Endoscopic methods are often used in the treatment of obstructive GAWs. We report the case of a patient with a congenital non-obstructive Antral gastric Web. The pa-tient was a 25-year-old male with gastrointestinal hem-orrhage followed by dyspeptic complaints. There was a follow-up period for the patient after treatment. Because GAWs are encountered and rarely reported in the litera-ture, the images taken during endoscopic surgery of the patient, as a significant contribution to the literature, are also presented

  • A non-obstructive gastric Antral Web case detected after upper gastrointestinal system bleeding
    'AVES Publishing Co.', 2019
    Co-Authors: Akbaş Enver, Altun Reskan
    Abstract:

    WOS: 000462165400021PubMed ID: 30289399This is the first study on the construction of the relationship between a non-obstructive gastric Antral Web and gastric-outlet obstruction in children and adults. Congenital or acquired gastric Antral Webs (GAWs) may cause gastric-outlet obstruction in children and adults. Endoscopic methods are often used in the treatment of obstructive GAWs. We report the case of a patient with a congenital non-obstructive Antral gastric Web. The patient was a 25-year-old male with gastrointestinal hemorrhage followed by dyspeptic complaints. There was a follow-up period for the patient after treatment. Because GAWs are encountered and rarely reported in the literature, the images taken during endoscopic surgery of the patient, as a significant contribution to the literature, are also presented

Marjorie J. Arca - One of the best experts on this subject based on the ideXlab platform.

  • Diagnosis and treatment of gastric Antral Webs in pediatric patients
    Surgical Endoscopy, 2019
    Co-Authors: Ruchi Amin, Alfonso M. Martinez, Marjorie J. Arca
    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  

  • Diagnosis and treatment of gastric Antral Webs in pediatric patients.
    Surgical endoscopy, 2018
    Co-Authors: Ruchi Amin, Alfonso Martinez, Marjorie J. Arca
    Abstract:

    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. 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. 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