Advanced endoscopic technique for treating antral web in pediatrics: A case series.

BACKGROUND: Antral web is an uncommon anomaly in pediatrics, characterized by a membranous relic vestige that can be a significant cause of gastric outlet obstruction. This condition can lead to misdiagnosis or delayed diagnosis due to clinical manifestations of food intolerance, non-biliary emesis, epigastric pain, that mirror other pathologies such as pyloric stenosis, gastroesophageal reflux, and peptic ulcer. Typically, treatment for this pathology is surgical intervention; however, four case reports are presented describing management through a less invasive endoscopic technique. CASE REPORTS: Four cases involving two children aged 2 years, 10 years, and 3 years are described. These cases presented inconclusive clinical data, leading to an upper endoscopy that revealed the presence of a web in the antral and prepyloric regions. Therefore, an outpatient and less invasive management option through endoscopic web resection is presented involving an incision with a sphincterotome followed by dilation with a hydrostatic balloon. CONCLUSIONS: Antral web should be considered in pediatric patients exhibiting gastric outlet obstruction symptoms. Once diagnosed, treatment can be carried out through an endoscopic web resection. However, there are limitations to this approach, as some membranes may reoccur, leading to re-stenosis, and then open surgery should be considered.