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Published on: December 1, 2012
Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome
Lara Lourenço1, Miguel Campos, Joaquim Monteiro
1Department of Pediatrics, Hospital S. João, Oporto, Portugal. larapslourenco@gmail.com
Insights
Serial transverse enteroplasty (STEP) is an effective surgical option for pediatric short bowel syndrome. This procedure can lead to improved oral/enteric feeding autonomy and growth in children with intestinal failure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intestinal Rehabilitation
Background:
- Short bowel syndrome (SBS) is a leading cause of intestinal failure in children.
- Current management relies on a multidisciplinary approach, including surgical interventions for intestinal lengthening.
- Serial transverse enteroplasty (STEP) has emerged as a revalued surgical technique for SBS.
Observation:
- A review of three pediatric patients undergoing STEP for SBS between April 2006 and December 2008 was conducted.
- No direct postoperative complications related to the STEP procedure were observed.
- Outcomes were evaluated for medium-term results, including feeding autonomy and growth.
Findings:
- Two out of three children achieved oral/enteric feeding autonomy within 3-7 months post-STEP, with sustained growth observed at 5-year follow-up.
- One child required intestinal transplantation 30 months post-STEP but demonstrated improved enteric volume, reduced dilation, and fewer occlusive episodes prior to transplant.
- STEP facilitated increased enteric volume and decreased intestinal complications in the patient awaiting transplantation.
Implications:
- STEP is a safe and effective technique for intestinal lengthening in pediatric SBS.
- The procedure can improve oral/enteric feeding tolerance and support growth in children with intestinal failure.
- STEP may serve as a beneficial intervention, potentially delaying or obviating the need for intestinal transplantation and alleviating SBS complications.
Abstract:
Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postoperative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the frequency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome.
