Gastrojejunal Stenosis of Gastric Bypass in Laparoscopic Bariatric Surgery: Report of a Case Julian Andres Tamayo Serrato * , Isabel Mateo Gavira, Francisco Javier Vilchez Lopez, Laura Larran Escandón, Manual Aguilar Diosdado, Maria Angeles Mayo Ossorio and Jose Pacheco García Department of Endocrinology & Nutrition, Puerta del Mar University Hospital, Cadiz, Spain * Corresponding author: Isabel Mateo Gavira, MD, PhD, Department of Endocrinology & Nutrition, Puerta del Mar University Hospital, Cadiz, Spain, Tel: +34 956003095; Fax: +34 956004600; E-mail: isamateogavira@gmail.com Rec date: Mar 25, 2015, Acc date: Mar 30, 2015, Pub date: Apr 10, 2015 Copyright: © 2015 Serrato JAT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Abstract Obesity is a chronic multifactorial disease, which results from the interaction between the genotype and the environment. It has become a public health problem across the world, with significant physical and psychological complications that contribute to the deterioration of the quality and expectancy of life. Gastric bypass is the most effective treatment option for the management of morbid obesity. Surgical treatment of obesity could reduce excess body weight by 50%-70% when compared to behavioral and pharmacological therapies. However, Gastrojejunal stricture (GYS) is the most common complication after laparoscopic gastric bypass, being that the pathophysiological mechanism involved not well understood. Presentation of Case: A 37-year-old man presented with progressive oral intolerance, incoercible vomiting, and high weight lost 2 months after Roux-en-Y gastric bypass (RYGBP). A severe stenosis was detected, pneumatic dilation made, and enteral nutrition required for several weeks. Keywords: Bariatric surgery; Gastrojejunal structure; Ballon dilation; Morbid obesity; Esophagogastric barium transit Introduction Bariatric surgery has shown to be an effective therapeutic modality for morbid obesity (BMI ≥ 40 kg/m 2 ). In Spain, as in other developed countries, the number of interventions has exponentially increased in recent years due to the progressive increment of obesity prevalence, failure of medical treatment and improvement in laparoscopic techniques. RYGBP, one of the most common surgical procedures, involves a small gastric pouch and a gastrojejunal anastomosis [1]. Laparoscopic approach offers clear advantages compared to open surgery, such as shorter hospital stay, shorter period of recovery, lower incidence of wound infections and less blood loss during surgery [2]. Case Report A 37-year-old man presented with 1 month of intermitent epigastric pain and abdominal bloating, progressive nausea and incoercible vomiting. He had a previous history of Roux-in-Y Gastric bypass 2 months before due to morbid obesity with a maximum weight of 140 kg (BMI 45 kg/m 2 ) and gastroesophageal reflux disease and hypertension as comorbidities. Post-operatively, barium transit had not shown anastomotic leakage (Figures 1 and 2), and he started with initial liquid diet and semi-solid diet thereafter. He later developed progressive oral intolerance, accelerating his weight loss to 92.8 kg (BMI 28 kg/m 2 ). He had no vitamin or hydroelectolityc disturbance, and the abdominal X-Ray was normal. An endoscopy was carried out, which showed a severe stenosis (<4 mm) with esophagogastric dilation and delayed gastric emptying (Figure 3). We performed a pneumatic dilation (3 sessions) every 3 days with progressive balloon diameter (6-8-10 mm). The long-term outcome was excellent without complications or failure. He started enteral nutrition, and a liquid diet was kept for several weeks. Figure 1: Gastrojejunal strictures after gastric bypass. Figure 2: esophagogastric barium transit after surgery. Serrato et al., J Gastrointest Dig Syst 2015, 5:2 DOI: 10.4172/2161-069X.1000275 Case Report Open Access J Gastrointest Dig Syst ISSN:2161-069X JGDS, an open access journal Volume 5 • Issue 2 • 1000275 J o u r n a l o f G a s t r o i n t e s t i n a l & D i g e s t i v e S y s t e m ISSN: 2161-069X Journal of Gastrointestinal & Digestive System