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Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome
Paul W Wales1, Nicole de Silva, Jacob C Langer
1Division of General Surgery, The Hospital for Sick Children, Toronto, Canada M5G 1X8. paul.wales@sickkids.ca
Insights
The serial transverse enteroplasty (STEP) procedure shows promising clinical and biochemical improvements in intestinal function for patients with short bowel syndrome. This novel intestinal lengthening technique offers hope for enhanced absorptive capacity and reduced parenteral nutrition dependence.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Intestinal surgery
Background:
- Serial transverse enteroplasty (STEP) is a surgical technique for intestinal lengthening, introduced in 2003.
- Objective assessment of intestinal absorptive capacity following STEP has not been previously reported in human studies.
- This study aims to evaluate intermediate clinical and biochemical outcomes of STEP.
Purpose of the Study:
- To assess the clinical and biochemical outcomes of the serial transverse enteroplasty (STEP) procedure.
- To evaluate changes in intestinal absorptive capacity post-STEP.
- To report intermediate outcomes in patients who underwent STEP at the institution.
Main Methods:
- A review of 14 patients who underwent STEP since May 2003.
- Clinical outcomes (weight gain, enteral tolerance, stool frequency) and biochemical markers (citrulline, D-xylose absorption, alpha-1 antitrypsin clearance, fecal fat) were assessed pre- and post-STEP at 1, 6, and 12 months.
- Paired t tests were used for statistical analysis; P < .05 was considered significant.
Main Results:
- STEP resulted in a mean increase in dilated bowel segment length of 94% and total small bowel length of 49%.
- Patients showed significant improvements in clinical parameters and intestinal absorptive function.
- Seven of eight patients with over one year follow-up weaned from parenteral nutrition; complications included staple line leaks and bleeding.
Conclusions:
- The serial transverse enteroplasty (STEP) procedure demonstrates promising intermediate clinical and objective biochemical outcomes.
- STEP shows potential for improving intestinal function and absorptive capacity in patients with short bowel syndrome.
- Further research is warranted to confirm long-term efficacy and safety.
Background:
Serial transverse enteroplasty (STEP) is a novel intestinal lengthening procedure introduced in 2003. To date, no human studies exist that report objective assessment of intestinal absorptive capacity. The aim of this study was to report intermediate outcomes in patients who have received the STEP at our institution using clinical and biochemical assessment of intestinal function.
Methods:
All 14 patients who received the STEP since May 2003 were reviewed. Clinical (weight gain, enteral tolerance, stool frequency) and biochemical (citrulline levels, D-xylose absorption, alpha-1 antitrypsin clearance, and fecal fat content) outcomes were performed pre-STEP and post-STEP at 1, 6, and 12 months, respectively. Data are presented as means with standard deviation. Paired t tests were used to compare post-STEP outcomes with pre-STEP values (P < .05 was significant). Three patients had a STEP as a newborn and are analyzed separately.
Main Results:
There were 14 patients (3 females; mean age, 24.8 months; range, 1 day-14 years). Serial transverse enteroplasty resulted in a mean increase in length of dilated bowel segment of 94% +/- 30% and increase in total small bowel length of 49% +/- 42% with mean application of 16 +/- 9 cartridges and cost of Can$2878.51 +/- 1406.22. Patients demonstrated improvement in both clinical parameters, as well as intestinal absorptive function. Complications included 2 patients with staple line leak and 1 patient with gastrointestinal bleeding from staple line ulcers. Three patients died (2 from liver failure and 1 from sepsis and congenital heart disease). Two patients received liver-intestinal transplants at 4 and 5 months post-STEP. Mean follow-up was 23 +/- 9 months, with 7 patients followed more than 2 years. Of 8 patients with post-STEP follow-up of more than 1 year, 7 have weaned from parenteral nutrition.
Conclusion:
Clinical and objective biochemical outcomes of intestinal function after the STEP procedure show promise after intermediate follow-up.
