This is a 65 year old female with no other significant past medical or surgical history, with a two year history of post-prandial epigastric pain and bloating, odynophagia, globus sensation, and a 20 pound unintentional weight loss. After failing conservative management with high-dose PPI, an EGD was performed that diagnosed a stricture at what they believed to be the pylorus. Biopsies showed benign inflammation and were negative for H pylori. Subsequent gastric emptying studying confirmed severe gastroparesis. She was placed on Reglan and dilated six times over a period of two years. After referral to the interventional endoscopists at our tertiary academic center, she underwent another endoscopic dilations. The endoscopist was able to traverse the 2mm stricture and found 2cm of antrum distal to the stricture, and a normal appearing true pylorus. Unfortunately the stricture recurred following each dilation. In a final attempt, a self-expanding metal stent was placed across the stricture, but was removed after one month with no improvement in symptoms and patient discomfort. Following this, she was referred to our GI surgery clinic. After dietary counseling and an empiric course of triple-therapy for H pylori, she underwent laparoscopic antrectomy with Billroth II reconstruction. She was discharged home on postoperative day 3 tolerating a pureed diet, and has had complete resolution of symptoms and is tolerating a regular diet at 3 month follow up.