Establish enteral feeding

Diabetic gastroparesis refractory to medical treatment is a rare but major management problem. Its previously poor prognosis, however, has been improved recently by the use of percutaneous endoscopic gastrojejunostomy with enteral feeding.1

In patients presenting with intractable vomiting it is important in the planning of management that the cause of vomiting is clearly established. Features in this case which point to a diagnosis of gastroparesis are the history of vomiting food that had been consumed a few days earlier, the large amount of residue in the stomach on gastroscopy in the absence of mechanical obstruction or mucosal abnormalities, delayed gastric emptying on scintigraphic studies, difficulties in diabetic control resulting from …