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Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding
Javier Bueno1,2, Laura García-Martínez1, Susana Redecillas1
1Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain.
Insights
The modified Serial Transverse Enteroplasty (MSTEP) procedure shows promise for achieving enteral autonomy in pediatric short bowel syndrome (SBS) patients. This technique, applicable to the duodenum, resulted in 73% of patients achieving autonomy, influenced by retained colon length.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Pediatric short bowel syndrome (SBS) presents significant challenges in achieving enteral autonomy.
- The Serial Transverse Enteroplasty (STEP) Registry reported a 47% success rate for enteral autonomy.
- A modified STEP (MSTEP) technique was developed, avoiding mesenteric defects and applicable to the duodenum.
Purpose of the Study:
- To describe the experience and outcomes of the modified Serial Transverse Enteroplasty (MSTEP) procedure in children with SBS.
- To evaluate the MSTEP technique's effectiveness in achieving nutritional and bacterial overgrowth treatment.
Main Methods:
- Sixteen children with SBS underwent the MSTEP procedure between 2005 and 2019.
- Indications included achieving nutritional autonomy (11 patients, 5 with duodenal lengthening) and treating bacterial overgrowth (5 patients).
- Follow-up median was 5.8 years.
Main Results:
- Overall, 73% of patients achieved enteral autonomy after MSTEP and potential redo procedures, including all cases with duodenal lengthening.
- A significant correlation was observed between retained colon length and enteral autonomy (p < 0.05).
- Patients treated for bacterial overgrowth showed improved metabolic/nutritional status.
Conclusions:
- The MSTEP technique demonstrates comparable effectiveness to the classical STEP for achieving enteral autonomy in pediatric SBS.
- MSTEP is a viable option for duodenal lengthening in SBS patients.
- Retained colon length is a critical factor influencing post-MSTEP enteral autonomy achievement.
Background:
The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described.
Materials And Methods:
In this study, 16 children with SBS underwent MSTEP (2005-2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5).
Results:
With a median follow-up of 5.8 years (0.7-13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines.
Conclusion:
The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.
