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Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review
Sjoerd C J Nagelkerke1,2,3, M Y van Poelgeest4, L M Wessel5
1Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Amsterdam, The Netherlands.
Insights
This study compares two bowel lengthening surgeries for short bowel syndrome (SBS) in children: longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP). Both are valuable, but patient selection and outcomes require further standardized research.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Evidence Appraisal
Background:
- Short bowel syndrome (SBS) presents a significant challenge in pediatric care.
- Surgical interventions aim to improve intestinal length and function.
- Longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) are key surgical techniques.
Purpose of the Study:
- To systematically assess and critically appraise evidence on LILT versus STEP for pediatric SBS.
- To identify patient characteristics associated with favorable outcomes after these procedures.
Main Methods:
- Comprehensive literature search of MEDLINE, EMBASE, and CENTRAL databases.
- Inclusion of 40 studies encompassing 782 pediatric patients.
- Qualitative synthesis due to heterogeneity preventing meta-analysis.
Main Results:
- Post-STEP, 46% weaned off parenteral nutrition (PN); post-LILT, 52% weaned off PN.
- Mortality rates were 7% for STEP and 26% for LILT.
- Predictive patient characteristics for success showed inconsistent results across studies; reporting quality was poor to fair.
Conclusions:
- Both LILT and STEP are viable surgical options for pediatric SBS.
- Current evidence is insufficient for precise patient selection or outcome prediction.
- Standardized, prospective outcome reporting via an international network is crucial.
Introduction:
The aims of the study are to systematically assess and critically appraise the evidence concerning two surgical techniques to lengthen the bowel in children with short bowel syndrome (SBS), namely, the longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP), and to identify patient characteristics associated with a favorable outcome.
Materials And Methods:
MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception till December 2019. No language restriction was used.
Results:
In all, 2,390 articles were found, of which 40 were included, discussing 782 patients. The median age of the patients at the primary bowel lengthening procedure was 16 months (range: 1-84 months). Meta-analysis could not be performed due to the incomparability of the groups, due to heterogeneous definitions and outcome reporting. After STEP, 46% of patients weaned off parenteral nutrition (PN) versus 52% after LILT. Mortality was 7% for STEP and 26% for LILT. Patient characteristics predictive for success (weaning or survival) were discussed in nine studies showing differing results. Quality of reporting was considered poor to fair.
Conclusion:
LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. Homogenous, prospective, outcome reporting is necessary, for which an international network is needed.
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