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Five-year outcomes after serial transverse enteroplasty in children with short bowel syndrome
Carol Oliveira1, Nicole de Silva, Paul W Wales
1Division of General Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Serial transverse enteroplasty (STEP) significantly increased small bowel length and improved intestinal absorption in pediatric patients. Most patients were weaned off parenteral nutrition, demonstrating robust long-term outcomes.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Intestinal adaptation
Background:
- Serial transverse enteroplasty (STEP) is a surgical procedure to lengthen the small intestine in patients with short bowel syndrome.
- Long-term outcomes of STEP, particularly beyond 5 years, require further investigation.
Purpose of the Study:
- To report 5-year clinical and biochemical outcomes following serial transverse enteroplasty (STEP).
- To assess the long-term efficacy of STEP in improving intestinal function.
Main Methods:
- Retrospective analysis of 12 patients who underwent STEP before January 2005.
- Annual clinical and biochemical assessments pre- and post-STEP.
- Paired t tests used for statistical comparison.
Main Results:
- STEP increased dilated bowel segment length by 89% and total small bowel length by 46%.
- Of 8 patients with stable absorptive capacity, 7 were weaned off parenteral nutrition by 4 years.
- No repeat STEP or bowel tapering was required; however, complications included staple line leak and gastrointestinal bleeding.
Conclusions:
- This study presents the largest series of STEP patients with over 5 years of follow-up.
- Long-term clinical, biochemical, and radiologic outcomes following STEP appear to be robust.
Aim:
The aim of this study is to report 5-year outcomes in patients who have received serial transverse enteroplasty (STEP) using clinical and biochemical assessments of intestinal function.
Methods:
Thirty-one STEP procedures have been performed at our institution. Twelve patients who received STEP before January 2005 were analyzed. Clinical and biochemical outcomes were performed pre-STEP and post-STEP on an annual basis. Paired t tests were used to compare post-STEP outcomes to pre-STEP values (P < .05 was significant).
Main Results:
There were 12 patients (3 females; median age, 5.5 months). Serial transverse enteroplasty resulted in mean increase in length of dilated bowel segment of 89% ± 26% and increase in total small bowel length of 46% ± 40%. Two patients received liver-intestinal transplants post-STEP (at 4 and 5 months), and 2 patients died of liver failure at 3 and 8 months. The remaining 8 of 12 patients all show stable intestinal absorptive capacity (data not shown). Of 8 patients, 7 were weaned off parenteral nutrition by 4 years. No patient has required repeat STEP or bowel tapering. Two patients developed staple line leak, and 1 patient developed gastrointestinal bleed from staple line ulcers.
Conclusion:
This report represents the largest series of STEP patients followed up beyond 5 years. Long-term clinical, biochemical, and radiologic outcomes appear to be robust.
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