ENDOSCOPIC BLIND LIMB REDUCTION WITH SEPTOTOMY FOR THE TREATMENMT OF CANDY CANE SYNDROME AFTER ROUX-EN-Y GASTRIC BYPASS. A PILOT FESIBILITY STUDY

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.