Morales Shannon J, Nigam Neha, Chalhoub Walid M, Abdelaziz Dalia I, Lewis James H, Benjamin Stanley B
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.
World J Gastrointest Endosc. 2017 Jan 16;9(1):19-25. doi: 10.4253/wjge.v9.i1.19.
To investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients.
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.
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 ( = 24, 70.6%) followed by abdominal pain ( = 11, 33.4%), nausea and vomiting ( = 9, 26.5%), dysphagia (n = 6, 17.6%), unexplained weight loss, ( = 4, 11.8%), early satiety ( = 4, 11.8%), and melena of unclear etiology ( = 3, 8.82%). Four of five GOO patients were treated with balloon dilation ( = 4), four-quadrant needle-knife incision ( = 3), and triamcinolone injection ( = 2). Three of these patients required repeat intervention. One patient had a significant complication of perforation after needle-knife incision.
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.
探讨成人胃窦蹼（GAW）的当前治疗方法，并确定这些患者的最佳内镜和/或手术治疗方案。
我们回顾了内镜数据库，以确定在一家三级医疗中心7年期间（2006 - 2013年）24640例食管胃十二指肠镜检查（EGD）中发现有GAW的患者。如果胃窦孔径不随蠕动变化或上消化道造影出现“双球”征，则在EGD期间怀疑有GAW诊断。通过证明GAW远端幽门正常来确诊。
我们确定了34例符合纳入标准的患者（发病率0.14%）。其中，5例患者出现胃出口梗阻（GOO），4例患者接受了反复序贯球囊扩张和/或针刀切开并注射类固醇以缓解GOO。其他29例患者偶然发现有非梗阻性GAW。诊断时年龄在30 - 87岁之间。非梗阻性GAW大多是偶然发现。促使进行内镜检查的最常见症状是难治性胃食管反流（n = 24，70.6%），其次是腹痛（n = 11，33.4%）、恶心和呕吐（n = 9，26.5%）、吞咽困难（n = 6，17.6%）、不明原因体重减轻（n = 4，11.8%）、早饱（n = 4，11.8%）和病因不明的黑便（n = 3，8.82%）。5例GOO患者中有4例接受了球囊扩张（n = 4）、四象限针刀切开（n = 3）和曲安奈德注射（n = 2）。其中3例患者需要重复干预。1例患者在针刀切开后出现穿孔的严重并发症。
使用球囊扩张或针刀切开对GAW进行内镜干预通常在缓解症状方面是安全有效的，然而可能需要重复治疗，并且热疗法存在穿孔风险。
