Magnet and wire remodeling for the treatment of candy cane syndrome: first case series of a new approach (with video)

• Published in: Gastrointestinal endoscopy 2022-06, Vol.95 (6), p.1247-1253
• Main Authors: Rio-Tinto, Ricardo, Huberland, François, Van Ouytsel, Pauline, Delattre, Cécilia, Dugardeyn, Sonia, Cauche, Nicolas, Delchambre, Alain, Devière, Jacques, Blero, Daniel
• Format: Article
• Language: English
• Subjects: Candy; Canes; Deglutition Disorders - etiology; Deglutition Disorders - surgery; Gastric Bypass - adverse effects; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - surgery; Humans; Laparoscopy - methods; Magnets; Obesity, Morbid - surgery; Pain - etiology; Postoperative Complications - surgery; Quality of Life; Syndrome; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2021.12.027

Candy cane syndrome (CCS) is an adverse event (AE) from gastrectomy or gastric bypass and end-to-side anastomosis to a jejunal loop. Preferential passage of food to the blind loop induces early satiety, pain, and regurgitation. An endoscopic device that combines 2 magnets and a self-retractable wire was designed to perform progressive septotomy with marsupialization. We evaluated the clinical safety and efficacy of this treatment in CCS. Consecutive patients presenting with symptoms associated with CCS after gastrectomy or Roux-en-Y gastric bypass were treated with the MAGUS (Magnetic Gastrointestinal Universal Septotome) system. Weight, dysphagia, pain scores, 12-item Short Form Survey quality of life physical and mental scores, GERD Health-Related Quality of Life, and Eckardt score were measured at baseline and 1 and 3 months postprocedure. Satisfaction with therapy and AEs were monitored during follow-up. Fourteen consecutive patients with CCS were enrolled in the study. Thirteen MAGUS systems migrated within 28 days after achieving uneventful complete septotomy. In 1 patient the magnet had to be collected from the right-sided colon after 1 month. Treatment was completed in a single endoscopy session. Dysphagia score (2 [1-3] vs 1 [1-1], P = .02), pain score (7 [6-8] vs 1 [0-1], P = .002), Eckardt score (5 [3-8] vs 1 [0-2], P = .002), GERD Health-Related Quality of Life score (37 [29-45] vs 8 [6-23], P = .002), and quality of life physical and mental scores were all significantly improved at 3 months. No device or procedure-related serious AEs were observed. One patient died during follow-up from evolution of oncologic disease. Endoluminal septotomy using a retractable wire and magnet system in CCS is feasible and safe, with rapid improvement of symptoms. (Clinical trial registration number: NCT04480216.)