As the GJ was easyly passed with the gastroscope I would redo this investigation. In diabetes we see a lot of gastroparalysis due to nerve dammage.

If your patient is overweight i would convert this to a gastric bypass situation with a smaller pocket size. The technic of anastomosis is the same I use with very good results.

If a stenosis is encountered on gastroscopy one might perform a dilatation. The reason for the stenosis could be stoma ulcer or ischemic.  Recurrence is to be expected.

I agree with Jutten. If gastroscope easily pass to jejunum, there is no gastrojejunal obstruction. It may be gastroparalysis due to diabetes mellitus. In this situation some gastrokinetic medicines can be used. If it is useless surgery can be performed

I would "sleeve" the proximal stomach up to the level of the anastomosis which will improve the gastroparesis and allow better emptying.

He was well for over 18 months when he devleped recurrent symptoms.For over 2 months he was on prokinetics.Then only upper GI scopy and cect were done.Thankyou

Dear colleagues. Of course it may be the result of nervous disorders due to diabetes. Initially, therefore, it is advisable to undertake a course of conservative therapy. But if symptoms will persist, it could be due: 1. anastomosis is side  to side, 2.and it is anterior. In my experience, even posterior GJ not always well draine the stomach. In such cases, we perform antrum resection with the proximal resection line immediately near the GJ or  Roux-en-Y reconstruction . We transform side to side into end to side or end to end anastomosis (open procedure). Roux is better.

Treatment can be performed with endoscopic dilations with pre procedural 4 quadrant precut incisions and then balloon dilation. It works great on anastomotic strictures.

First  think is mandatory in these case to attend or to perform the endoscopy. You report the GJ diameter of 3.8 mm and the scope is easily passing. It is difficult to understand how it is measured with such precision (0.1 mm) by endoscopy. This situation is impossible as the diameter of the the gastroscope is 10 mm. If there is typo and the diameter is 38 mm or 3.8 cm then there is no stenosis and the hypothesis of paresis is true. It is described in the literature and in 2 cases it was very useful the concept of "sleeving" the stomach -  good point Dr. Borao.

If there is a stenosis (diameter 3 - 4 mm) repetitive endoscopic dilation must be done. In case of failure of endoscopic approach after 3 to 5 sessions, the surgical approach with resection of the distal stomach and the anastomosis must be discussed. Before that the tabacco use must be eliminated. We are knowing from RYGBP the risk to develop recurrent ulcer and the stenosis of the anastomosis for smockers

Dear dr Marius,

Measurement was done as per the stoma on CECT,Ido agree it is a static image.thankyou,

Dear Dr Reddy,

it is unsual, late after Lap gbp, a patient to develop GJ stenosis. It is necessary to treat and I' d do it by endoscopic pneumatic balloon dilation, but has to find the cause. Mostly the stenosis were caused by peptic ulcer, but isquemia at the alimentary limb or even extrinsic compression by chronic internal hernia above the colon as wel as tumors, peritoneal cysts. We observed it in a case with invasive transverse colon cancer.

Carlos Madalosso, Gastrobese Clinic

http://link.springer.com/article/10.1007/s11695-008-9588-6

Dear dr karlos,how about a markedlly dilated stoamch due to duodenal obstruction,after GJ ,can the stoma shrink after decopression.

if it is a long stricture they need surgery. if they smoke that is a problem. short strictures and be dilated and then injected with steroids by endoscopy

Truncal vagotomy in a diabetic pt may lead to worsening of gastroparesis.  Stenosis can also occur also by over stretching of the bowel walls between the stapled line (concertina effect)