Retrograde device-assisted lumen-apposing metal stent insertion for candy cane syndrome

Q3 Medicine

VideoGIE Pub Date : 2025-04-22 DOI:10.1016/j.vgie.2025.04.006

Anne Kimberly Lim-Fernandez MD , Samuel Jun Ming Lim MRCP , Chin Hong Lim MRCP , Christopher Jen Lock Khor MRCP , Damien Meng Yew Tan MRCP

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引用次数: 0

Abstract

Background and Aims

Candy cane syndrome is a rare adverse event of gastric bypass or gastrectomy, where a blind jejunal pouch fills with food, causing dilation and compression of the efferent limb, leading to obstructive symptoms like vomiting and regurgitation. Surgical resection is curative but technically challenging, and endoscopic treatment using lumen-apposing metal stent (LAMS) insertion has been attempted.

Methods

This case describes a retrograde LAMS insertion in a patient with previous total gastrectomy who presented a decade later with dysphagia and food regurgitation. Imaging revealed an enlarged blind jejunal pouch and migration of the esophagojejunostomy anastomosis above the diaphragm and into the thoracic cavity. A tandem endoscopic approach with an ultraslim gastroscope and an echoendoscope was used to place a LAMS from the efferent limb into the blind pouch. The gastroscope is used to assist with instillation of saline and endoscopic visualization of the LAMS in the blind pouch to ensure safe deployment. A retrograde approach from the efferent limb to the blind pouch allows a larger and more stable target for puncture, and a better LAMS axis for effective diversion of food.

Results

He gained 9 kg over 4 months after the procedure and was able to tolerate a normal diet. The LAMS was planned for removal after 10 to 12 months to allow longer indwelling time and greater rate of patency.

Conclusions

Endoscopic management with EUS-guided LAMS insertion is a promising alternative to surgical resection for candy cane syndrome.

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逆行装置辅助置管金属支架治疗拐杖糖综合征

背景和目的胰管综合征是胃旁路或胃切除术的一种罕见的不良事件，其中盲肠袋充满食物，导致传出肢扩张和压迫，导致呕吐和反流等阻塞性症状。手术切除是治愈性的，但技术上具有挑战性，内镜下使用腔内金属支架（LAMS）插入治疗已被尝试。方法本病例描述了一名既往全胃切除术患者的逆行LAMS插入，该患者在十年后出现吞咽困难和食物反流。影像显示一个增大的盲肠袋和食管-空肠吻合术在膈上方向胸腔内迁移。采用超薄胃镜和超声内镜的串联内镜入路，将LAMS从传出肢体放入盲袋中。胃镜用于协助生理盐水的滴注和在盲袋内的LAMS的内镜可视化，以确保安全部署。从传出肢到盲袋的逆行入路可以提供更大更稳定的穿刺目标，以及更好的LAMS轴以有效转移食物。结果术后4个月内体重增加9公斤，饮食正常。LAMS计划在10至12个月后取出，以延长留置时间和提高通畅率。结论超声引导下LAMS植入术是替代手术治疗甘蔗糖综合征的有效方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.