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Improved enteral tolerance following step procedure: systematic literature review and meta-analysis

Melissa A Fernandes1, Danielle Usatin1, Isabel E Allen2

  • 1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, USA.

Pediatric Surgery International
|July 28, 2016
PubMed

Insights

The serial transverse enteroplasty (STEP) procedure significantly improves enteral tolerance in children with short bowel syndrome (SBS). Most patients experienced enhanced nutritional intake after STEP surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Innovation

Background:

  • Short bowel syndrome (SBS) presents significant challenges in pediatric nutrition.
  • The serial transverse enteroplasty (STEP) procedure emerged as a surgical option to manage SBS.
  • Evaluating the efficacy of STEP in improving enteral tolerance is crucial.

Purpose of the Study:

  • To systematically review and meta-analyze the impact of the STEP procedure on enteral tolerance in children with SBS.
  • To determine the proportion of pediatric SBS patients who demonstrate improved enteral tolerance post-STEP.
  • To assess the overall efficacy of STEP as a treatment for SBS.

Main Methods:

  • Systematic review and meta-analysis of studies from MEDLINE and SCOPUS.
  • Inclusion criteria: studies reporting pre- and post-STEP enteral tolerance in pediatric SBS patients.
  • Random effects meta-analysis to estimate the pooled proportion of patients with increased enteral tolerance.

Main Results:

  • Seven case series involving 86 children were included in the analysis.
  • Mean enteral nutrition tolerance increased from 35.1% to 69.5% post-STEP.
  • A summary estimate indicated that 87% (95% CI 77-95%) of children showed improved enteral tolerance after STEP.

Conclusions:

  • The literature supports that the STEP procedure enhances enteral nutritional tolerance in children with SBS.
  • Enteral nutritional tolerance serves as a key measure for STEP efficacy and should be a primary or secondary outcome.
  • Standardized data collection is recommended to better ascertain the nutritional benefits of the STEP procedure.

Keywords:
Enteral nutritionMeta-analysisSTEPSerial transverse enteroplasty procedureShort bowel, short gut

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