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Endoscopic blind limb reduction with septotomy for the treatment of candy cane syndrome after Roux-en-Y gastric
Kambiz Kadkhodayan1, Zubair Khan2, Shayan Irani3
1Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States.
Background And Study Aims:
Candy cane syndrome (CCS) refers to patients with a long and symptomatic blind afferent roux limb (BARL) after Roux-en-Y gastric bypass (RYGB). Revisional surgery is efficacious but can be cost prohibitive.
Patients And Methods:
We describe endoscopic blind limb reduction (EBLR), that converts the BARL into a "common channel" and eliminates food pooling, thereby improving symptoms. Patients that did not have a complete symptomatic response underwent a repeat EBLR or EBLR with septotomy (EBLR-S) based on residual BARL length.
Results:
Five patients with CCS underwent the EBLR procedure. Mean age was 60.4 years, average BARL length 5.8 cm, and median Charlson comorbidity index was 3. Technical success was achieved in all five patients (100%). Symptom resolution was achieved in all five patients (100%). Two patients required a second procedure.
Conclusions:
EBLR may be a potentially safe, efficacious, and cost-effective alternative to surgery in patients with CCS. Further prospective studies are needed.
