Antral web associated with distal antral hypertrophy and prepyloric stenosis mimicking hypertrophic pyloric stenosis

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

BACKGROUND

The incidence of gastric cancer remains high, and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide. Oral contrast-enhanced ultrasonography is a simple, non-invasive, and painless method for the diagnosis of gastric tumors.

AIM

To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors.

METHODS

The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination.

RESULTS

Among 42 patients with gastric tumors enrolled in the study, the diagnostic accordance rate was 95.2% for oral contrast-enhanced ultrasonography (n = 40) and 90.5% for electronic gastroscopy (n = 38) compared with postoperative pathological examination. The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy, and there was no significant difference between them (P = 0.397). For the TNM staging of gastric tumors, the accuracy rate of oral contrast-enhanced ultrasonography was 81.9% for the overall T staging and 50%, 77.8%, 100%, and 100% for T1, T2, T3, and T4 staging, respectively. The sensitivity and specificity were both 100% for stages T3 and T4. The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%, 80%, 100%, and 100% for stages N0, N1-N3, M0, and M1, respectively.

CONCLUSION

The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy, and it could be used as the preferred method for the early screening of gastric tumors.

Pyloric Mucosal Diaphragm Associated with Hypertrophic Pyloric Stenosis: An Unusual Combination in a Male Neonate

We describe herein the case of a 3-week-old baby with persistent nonbilious vomiting, due to a hypertrophic pyloric stenosis (HPS) associated with a congenital pyloric mucosal diaphragm. So far, an association between the two conditions has not been described. The diagnosis of a pyloric mucosal diaphragm was delayed because of its cooccurrence with HPS.

Treatment of Congenital Gastric Outlet Obstruction due to a Web: A Retrospective Single-center Review

BACKGROUND

Congenital gastric antral web and congenital pyloric atresia are rare reasons of congenital gastric outlet obstruction (CGOO). Depending on the different forms, the symptoms vary from unspecific epigastric pain to nonbilious "projectile" vomiting, ileus and failure to thrive. Throughout the years, many different treatment options are described, like simple surgical dilatation, incision or excision of the membrane, possibly combined with a pyloroplasty.

PATIENTS AND METHODS

In this retrospective single-center observation study, we present 9 cases with different kinds of webs leading to CGOO. In a time period of 45 years (1970 to 2015) different treatment strategies and limitations of minimal invasive endoscopic treatment on the basis of complications and outcome are discussed.

RESULTS

Six patients had an incomplete antrum web. One patient suffered from a complete antrum web. In addition, in 2 patients a complete pyloric web, as well as an incomplete pyloric web was found. During the past 45 years, the treatment options for CGOO due to webs changed, and with the development of smaller and more flexible video endoscopes an endoscopic treatment has become feasible. The treatment strategy and follow-up examination was specific to every patient.

CONCLUSION

On the basis of our review, minimal endoscopic procedures in small newborns and toddlers require a high level of experience. They are technically challenging and need suitable equipment. Overall, endoscopists and pediatric surgeons should equally be prepared for all possible complications in every treatment step. The endoscopic approach to managing this unusual disease may require multiple interventions and is associated with a risk of perforation. Therefore, we are convinced that centers undertaking this treatment modality should be equipped with the proper instrumentation, prepared to perform multiple endoscopic interventions, and supported with an ability to emergently convert to surgery if required.

The value of oral contrast ultrasonography in the diagnosis of gastric cancer in elderly patients

BACKGROUND

This study aims to investigate the value of oral contrast ultrasonography (OCUS) in the diagnosis of gastric cancer in elderly patients.

METHODS

OCUS data obtained from patients ≥ 60 years old were retrospectively analyzed and compared with gastroscopy results.

RESULTS

Among the 12,716 subjects examined by OCUS, 5021 subjects were ≥ 60 years old, which accounted for 39.48% (5021/12,716). Gastritis, gastric polyp, benign ulcer, and gastric cancer were detected by OCUS in 1099 patients. Among them, 196 patients underwent gastroscopy. Furthermore, ulcerative lesions were detected in 32 patients by OCUS and in 51 patients by gastroscopy, and the coincidence rate was 62.74%. Among these patients, gastric cancer was diagnosed in 18 patients by OCUS with a detection rate of 1.64% (18/1099) and detected in 19 patients by gastroscopy with a diagnostic coincidence rate of 94.73% (18/19). Furthermore, benign ulcer was detected in 14 patients by OCUS and in 32 patients by gastroscopy, and the diagnostic coincidence rate was 43.75% (14/32).

CONCLUSION

OCUS helps to timely detect senile gastric cancer and can be used as a suitable technique for the detection of gastric diseases.

Congenital antral web in premature baby

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.

Congenital pyloric mucosal fold resulting in an antral valve outflow obstruction in a bull terrier

An under-sized three-month-old female bull terrier was referred with a history of regurgitation since three days of age. Thoracic radiographs were unremarkable, while abdominal radiographs showed a distended stomach, despite a 12 hour fast. Abdominal ultrasonography revealed gastric outflow obstruction of unclear aetiology. Coeliotomy was performed, during which an excessive mucosal fold at the pyloric antrum was excised. Histopathology of the pyloric fold revealed mild oedema and fibrosis of the mucosal tissue. The dog made a complete recovery, with resolution of regurgitation and grew to within the expected breed size. In the authors' opinion, this is the first canine report of congenital antral mucosal valve resulting in gastric outflow obstruction, and only the second report in any species.

Hydrosonography of the gastrointestinal tract

OBJECTIVE

Bowel sonography has become accepted as a useful tool in several gastrointestinal disorders. Filling of the gut with echo-poor liquids has been proposed to achieve a detailed evaluation of the bowel. This article refers to a review made concerning the benefits and limits of hydrosonography of the gastrointestinal tract.

CONCLUSION

The use of a luminal contrast agent in bowel sonography may improve results but should be adopted on a case-by-case basis, according to the clinical context and the experience of the sonologist.