MAGNET AND WIRE REMODELING FOR THE TREATMENT OF CANDY CANE SYNDROME: FIRST CASE-SERIES OF A NEW APPROACH

Aims Candy cane syndrome (CCS) is a complication after gastrectomy or gastric by-pass 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 two 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.

Methods Consecutive patients presenting with symptoms associated with CCS, after gastrectomy or Roux en Y gastric bypass (RYGBP) were treated with the MAGUS (MAgnetic Gastrointestinal Universal Septotome) system. Weight, dysphagia, and pain scores, SF12 QOL physical and mental scores, GERD-HRQL, and Eckardt score were measured at baseline, 1, and 3 months. Satisfaction with therapy and adverse events were monitored during follow-up.

Results Fourteen consecutive patients with CCS were enrolled in the study. Thirteen of the MAGUS systems migrated within 28 days after achieving uneventful complete septotomy. In one case, the magnet had to be collected from the right colon after one month. Treatment was completed in a single endoscopy session. Dysphagia score (2(1-3) vs 1(1-1), p=0.02, pain score (7(6-8) vs 1(0-1), p=0.002), Eckardt score (5(3-8) vs 1 (0-2) p=0.002), GERD HRQL score (37(29-45) vs 8(6-23), p=0.002), and QOL physical and mental scores were all significantly improved at 3 months. No device or procedure-related SAEs were observed. One patient died during follow-up from evolution of oncological disease.

Conclusions Endoluminal septotomy using a retractable wire and magnet system in CCS is feasible and safe, with rapid improvement of symptoms.

Publication History

Article published online:
14 April 2022