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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25097573
DOI: 10.1055/a-2509-7573
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Endoscopic blind limb reduction with septotomy for the treatment of candy cane syndrome after Roux-en-Y gastric bypass: Pilot feasibility study

Kambiz Kadkhodayan 
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Zubair Khan
2   Gastroenterology, Mercy Clinic Gastroenterology - Mercy Hospital, St. Louis, United States (Ringgold ID: RIN603803)
,
Shayan Irani
3   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
,
Artur Viana
1   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
4   Center for Interventional Endoscopy, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Deepanshu Jain
1   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
4   Center for Interventional Endoscopy, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Gustavo Bello Vincentelli
5   Bariatric Surgery, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
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Abstract

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.

Keywords

GI surgery - Endoscopy Small Bowel - Small bowel endoscopy


Publication History

Received: 25 October 2024

Accepted after revision: 19 December 2024

Accepted Manuscript online:
02 January 2025

Article published online:
05 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Kambiz Kadkhodayan, Zubair Khan, Shayan Irani, Artur Viana, Saurabh Chandan, Sagar Pathak, Abdullah Abassi, Mustafa A Arain, Maham Hayat, Deepanshu Jain, Dennis Yang, Muhammad Khalid Hasan, Gustavo Bello Vincentelli. Endoscopic blind limb reduction with septotomy for the treatment of candy cane syndrome after Roux-en-Y gastric bypass: Pilot feasibility study. Endosc Int Open 2025; 13: a25097573.
DOI: 10.1055/a-2509-7573
 

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