Endoscopic radial incision of a congenital antral web in a child

A 5-year-old boy presented with intermittent nonbilious vomiting for over 1 year. During the gastroscopy examination, an antral web with a central aperture was found with the pylorus visible in the distance ([Fig. 1]). A barium swallow test showed narrowing in the area of antrum and pylorus, but the contrast agent could still pass through ([Fig. 2]). The definitive diagnosis of "congenital antral web, incomplete antral web" was made. Endoscopic treatment was subsequently performed ([Fig. 3], [Video 1]). The web was incised directly using an insulated-tipped knife (Olympus, Tokyo, Japan) in a radial pattern at eleven, three, and seven o'clock until the circular muscle was completely cut, clearly exposing the antrum and pylorus. The endoscope was able to pass the pylorus smoothly after the incision. The patient was discharged in stable condition after 6 days without any adverse events. The patient's symptoms were significantly resolved and a follow-up endoscopy at 6 months suggested good wound healing and widened aperture of the residual web ([Fig. 4]).