Atypical Candy-cane syndrome (CCS) cases treated by a magnetic device

Aims Blind jejunal lopp syndrome may occur after gastric surgery such as gastrectomy or gastric bypass with end-to-side anastomosis, and is usually reported as CCS. Such Candy shaped (CS) deformation, with similar clinical consequences, may also occur postoperatively, at the level of the stomach, but litterature about it and its potential treatment is scarce [1] [2] [3].

Methods Over a 15months (15Mo) period, three patients with a symptomatic CS deformation were treated by placement of MAGUS device. The protocole was approved by accredited IRB and Belgian health authority.

Results Three patients had gastric deformation, Candy shaped, with a septum causing symptomatic luminal sub-obstruction. First patient (67y/o) had a sleeve gastrectomy, with a CS proximal deformation, creating a gastric blind pouch. The second patient (51y/o) had a sleeve gastrectomy performed during the undo of a previously performed gastric bypass, with gastro-gastric anastomosis deformation, inducing an antral septum. Last patient (44y/o) had esophagectomy for esophageal cancer, with end-to-side eso-gastric anastomosis, inducing a septum, with a deformation of the anastomosis resulting in a reverse candy-cane shaped picture. The device delivery was possible accross the septa in all patients, allowing the septotomy in a single endoscopic session. The two first patients were followed more than 3Mo, with spontaneous device migration at 1Mo, while the device, was endoscopically removed from the antrum in the third at 1Mo, after septotomy completion. This was considered as a mild adverse event since, per protocol, magnets were supposed to pass within 30 days.

At endoscopic control, all had their septa completely cut.

At 3Mo, Eckart score evolved, respectively for case 1 and 2, from 1 to 0 and from 5 to 1.

At 3Mo, pain visual analog scale improved, respectively, from 1/10 to 0/10 for case 1 and from 9/10 to 1/10 for case 2.

Case 3 is still on follow-up.

Conclusions This first case series suggests that endoluminal septotomy using MAGUS device is technically feasible and safe for the treatment of postoperative CS gastric deformation associated with dysphagia, pain and/or regurgitations.

Publication History

Article published online:
27 March 2025

• References

• 1 Rio-Tinto R, Huberland F, Van Ouytsel P, Delattre C, Dugardeyn S, Cauche N. et al. Magnet and wire remodeling for the treatment of candy cane syndrome: first case series of a new approach (with video). Gastrointest Endosc 2022; 95 (6): 1247-53
• 2 Huberland F, Rio-Tinto R, Cauche N, Dugardeyn S, Delattre C, Sandersen C. et al. Magnets and a self-retractable wire for endoscopic septotomies: from concept to first-in-human use. Endoscopy 2022; 54 (6): 574-9
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