title: Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Shannon J
authors.initials: SJ
authors.lastname: Morales
authors.affiliation: 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.
authors.forename: Neha
authors.initials: N
authors.lastname: Nigam
authors.affiliation: 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.
authors.forename: Walid M
authors.initials: WM
authors.lastname: Chalhoub
authors.affiliation: 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.
authors.forename: Dalia I
authors.initials: DI
authors.lastname: Abdelaziz
authors.affiliation: 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.
authors.forename: James H
authors.initials: JH
authors.lastname: Lewis
authors.affiliation: 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.
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Benjamin
keywords: Balloon dilation; Gastric antral web; Gastric outlet obstruction; Needle knife; Triamcinolone injection