Post written by Kambiz Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.

We describe a new endoscopic procedure to treat candy cane syndrome in Roux-en-Y gastric bypass patients. The syndrome refers to patients who have undergone Roux-en-Y gastric bypass and developed significant and sometimes debilitating postprandial abdominal discomfort that is often relieved by vomiting. This occurs because of the preferential pooling of food within the blind afferent Roux limb (BARL).  

Revisional surgery, although highly efficacious, can be cost prohibitive and is frequently associated with a high risk of adverse events. There is an urgent need for minimally invasive and cost-effective approaches to this morbid clinical problem.  

The endoscopic procedure we describe is performed in 2 steps. During the first step, the interjejunal septum (IJS) that separates the BARL from the afferent limb is sutured using an endoscopic suturing devise. This results in shortening of the septum, preemptive ligation of intervening blood vessels, and remodeling of the septum.

This is followed by a second step in 4 to 6 weeks, when the IJS is dissected using a standard scissor-type electrosurgical knife. This converts the BARL and IJS into a common channel that empties directly into the afferent limb, thus eliminating possibility of food pooling.

To our knowledge, this was the first-of-its-kind proof-of-concept procedure, and we felt it was important to demonstrate technical details using a video forum.

We display feasibility of an endoscopic procedure that uses sutures to shorten the BARL and ligate the IJS at 2 ends. In our case, this led to significant improvement of candy cane symptoms.

In addition, we show the feasibility of IJS dissection following placement of sutures. Further studies are needed to evaluate the procedure’s reproducibility, safety, and clinical efficacy.

I would like to thank GIE for the opportunity to share this novel procedure and encouraging clinical outcome.

Illustration depicting step 1 of the endoscopic blind limb reduction with septostomy procedure; a single suture is applied at each end of the interjejunal septum. Multiple passes or bites are taken with each suture at each end before cinching.

Read the full article online.

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