Intestinal lengthening in adult patients with short bowel syndrome

Limited information regarding the usefulness of bowel lengthening in adult patients with short bowel syndrome is available.

Retrospective review of a single center series of intestinal lengthening over 15-year period in patients ≥ 18 years old.

Twenty adult patients underwent Bianchi (n = 6) or serial transverse enteroplasty (STEP) (n = 15). Median age was 38 (18-66) years and 11 were female. Indications were (a) to increase the enteral caloric intake thereby reduce or wean parenteral nutrition (PN) (n = 14) or (b) for bacterial overgrowth (n = 6). Twelve patients required additional procedures to relieve the anatomical blockade. Median remnant bowel length prior to surgery, length gained and final bowel length was 60, 20, and 80 cm, respectively. Survival was 90% with mean follow-up of 4.1 years (range = 1-7.9 years). Two patients died during follow-up. Intestinal transplant salvage was required in one patient 4.8 years after STEP. Overall, of 17 patients, ten (59%) patients achieved enteral autonomy and were off PN. Of seven patients who are on PN, three patients showed significant improvement in enteral caloric intake. All except one showed significant improvement in symptoms of bacterial overgrowth.

Bowel lengthening is technically feasible and effectively leads to weaning from PN in more than half of the adult patients. Lengthening procedures may be an underutilized treatment for adults with short bowel syndrome.