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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2509-7573
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ENDOSCOPIC BLIND LIMB REDUCTION WITH SEPTOTOMY FOR THE TREATMENMT OF CANDY CANE SYNDROME AFTER ROUX-EN-Y GASTRIC BYPASS. A PILOT FESIBILITY STUDY

Kambiz Kadkhodayan 
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Zubair Khan
3   Gastroenterology, Mercy Clinic Gastroenterology - Mercy Hospital, St. Louis, United States (Ringgold ID: RIN603803)
,
Shayan Irani
4   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
,
Artur Viana
2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Saurabh Chandan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Sagar Pathak
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Abdullah Abassi
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Mustafa A Arain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Maham Hayat
5   Center for Interventional Endoscopy, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Deepanshu Jain
2   Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Dennis Yang
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Muhammad Khalid Hasan
6   Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States (Ringgold ID: RIN6244)
,
Gustavo Bello Vincentelli
7   Bariatric Surgery, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
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Background: 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. 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: A total of five patients with CCS underwent the EBLR procedure. Mean age 60.4 years, average BARL length 5.8 cm, median Charlson comorbidity index of 3. Technical success was achieved in all 5 patients (100%). Symptom resolution was achieved in all 5 patients (100%). Two patients required a second procedure. Conclusion: EBLR may be a potentially safe, efficacious and cost-effective alternative to surgery in patients with CCS. Further prospective studies are needed.



Publication History

Received: 25 October 2024

Accepted after revision: 19 December 2024

Accepted Manuscript online:
02 January 2025

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