Retrograde device-assisted lumen-apposing metal stent insertion for candy cane syndrome

Area of Science:

• Gastroenterology
• Surgical Complications
• Endoscopic Procedures

Background:

• Candy cane syndrome is a rare complication following gastric bypass or gastrectomy.
• It involves a blind jejunal pouch filling with food, causing obstructive symptoms like vomiting.
• Surgical resection is curative but challenging; endoscopic treatment with lumen-apposing metal stents (LAMS) has been explored.

Purpose of the Study:

• To describe a novel endoscopic approach for managing candy cane syndrome.
• To evaluate the efficacy of retrograde lumen-apposing metal stent (LAMS) insertion in a complex case.

Main Methods:

• A retrograde lumen-apposing metal stent (LAMS) insertion was performed using a tandem endoscopic approach.
• An ultraslim gastroscope and an echoendoscope were utilized for precise stent placement.
• Saline instillation and endoscopic visualization ensured safe deployment of the LAMS from the efferent limb into the blind jejunal pouch.

Main Results:

• The patient experienced significant improvement, gaining 9 kg over 4 months.
• Normal diet tolerance was achieved post-procedure.
• The LAMS was intended for removal after 10-12 months to ensure long-term patency.

Conclusions:

• Endoscopic management using EUS-guided LAMS insertion is a viable and promising alternative to surgery for candy cane syndrome.
• This retrograde approach facilitates effective diversion of food and management of the condition.