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Serial Transverse Enteroplasty (STEP) for Short Bowel Syndrome (SBS) in Children: A Multicenter Study on Long-term
Claire Dagorno1, Louise Montalva2, Carmen Capito3
1Department of Pediatric Surgery, Robert-Debré Children's University Hospital, APHP, Paris, France; Department of General Pediatric Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France.
Insights
Serial transverse enteroplasty (STEP) improves outcomes for children with short bowel syndrome (SBS). This surgical technique increases bowel length, reduces parenteral nutrition (PN) dependency, and alleviates digestive symptoms, offering a viable treatment option.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intestinal Rehabilitation
Background:
- Short Bowel Syndrome (SBS) is a major cause of intestinal failure in children, often necessitating complex nutritional support.
- Serial Transverse Enteroplasty (STEP) is a surgical option for SBS, but long-term outcome data are limited.
Purpose of the Study:
- To evaluate the long-term outcomes of the STEP procedure in pediatric patients with SBS.
- To assess the impact of STEP on nutritional support, digestive symptoms, and overall growth.
Main Methods:
- A retrospective multicenter observational study was conducted across 6 university hospitals.
- Data from 36 children who underwent STEP between 2000 and 2022 were analyzed, including demographics, SBS history, surgical details, nutritional status, and outcomes.
Main Results:
- STEP significantly increased bowel length (47 to 70 cm, p < 0.01) and reduced parenteral nutrition (PN) dependency in 14 of 33 patients.
- Clinical symptoms improved, with 12 of 17 patients with bacterial overgrowth and 12 of 20 with obstructive symptoms achieving enteral autonomy or reduced PN needs.
- A median follow-up of 7 years revealed sustained benefits, though some patients required repeat procedures or intestinal transplantation.
Conclusions:
- The STEP technique is a valuable surgical option for managing pediatric SBS.
- It leads to improved bowel length, decreased reliance on PN, and significant amelioration of digestive symptoms.
- STEP offers a pathway towards improved nutritional independence and quality of life for children with SBS.
Objectives:
Short Bowel Syndrome (SBS), secondary to various underlying diseases, is one of the main causes of intestinal failure in children. Surgical management by serial transverse enteroplasty (STEP), is feasible in selected cases, but results on long-term follow-up are scarce. The aim of this study was to report long-term outcomes of the STEP procedure in children with SBS.
Methods:
We performed a multicenter national retrospective study reviewing medical charts of children who underwent a STEP technique between 2000 and 2022 in 6 university hospitals. Collected data included demographics, SBS history, surgical procedures, nutritional support (enteral or parenteral), STEP management, complications, and outcomes (nutritional support, digestive symptoms, growth).
Results:
STEP was performed in 36 SBS, resulting from 14 gastroschisis, 10 intestinal atresia, 8 necrotizing enterocolitis (NEC), 2 midgut volvulus, and 2 intestinal Hirschsprung disease. Median age at first STEP was 10.8 months [4.5; 63.8]. Bowel length significantly increased (47 vs 70 cm, p < 0.01), with a median gain of 16 cm [11; 25] or 34%. At surgery, 33 children had parenteral nutrition (PN). A second STEP was performed in 11 patients, at a median age of 4.2 years [2.8; 6.8]. One patient underwent a third STEP. Two children required intestinal transplantation. Median follow-up was 7 years [4.4;11.4]. Out of 33 children requiring PN before surgery, 14 children were weaned off PN. The remaining 19 children still required PN, but their dependency decreased by 19%. Out of 17 children presenting severe intestinal dilations and bacterial overgrowth, 12 became asymptomatic. Out of 20 with chronic obstructive symptoms, 8 patients still required supplementary PN whereas 12 achieved complete enteral autonomy, including 3 requiring supplementary enteral support.
Conclusion:
STEP technique remains a surgical option in the management of these children, enabling a decrease in PN dependency, resulting in weaning off PN in some cases, as well as an improvement of clinical symptoms.
Type Of Study:
Retrospective multicenter observational study.
Level Of Evidence:
Level 3.
