Endoscopic marsupialization for severe candy cane syndrome: long-term follow-up

Candy cane syndrome (CCS) is a clinical condition that may occur after gastrectomy or gastric bypass when an excessively long or mispositioned blind jejuna! loop proximal to the anastomosis is left in place. Preferential food passage in this loop results in symptoms such as fullness, pain, reflux, regurgitation. and postprandial vomiting. Surgical resection of the dilated loop is technically complex, and morbidity limits its use in fragile patients. An endoscopic approach, using dedicated active magnets, has recently been shown to be effective in the medium-term. We present here the case of a 71-year-old woman who underwent endoscopic treatment for the first time. She presented with intractable vomiting, food intolerance, and cachexia due to CCS after total gastrectomy for gastric cancer. Surgical treatment was not an option in such a high-risk patient, and she accepted treatment with a novel endoscopic approach using a double-magnet device followed by septotomy to marsupialize the blind loop. Her symptoms completely resolved and she regained weight. We report here the patient's clinical outcomes at 3 years, which suggest that endoscopic marsupialization for CCS is not only effective in the short term but also provides long-term clinical benefit.