Gastro-ileal Stenosis and Gastroparesis after a Biliopancreatic Diversion

Biliopancreatic diversion (BPD) is a very effective bariatric operation particularly for super-obese patients (BMI ≥50 kg/m2). We present the development of a stricture at the gastro-ileal anastomotic site, with subsequent dilatation and aperistalsis of the stomach in a female patient who had undergone a standard open Scopinaro BPD. The patient remained symptomatic and persisted in losing weight, despite endoscopic balloon dilatations of the stricture and surgical revision of the anastomosis. She finally underwent conversion to a standard Roux-en-Y proximal gastric bypass. We describe the development of the stricture after the use of the stapling gun, subsequent gastric dilatation and dysmotility.