Serial Transverse Enteroplasty and the Reestablishment of Enteral Autonomy Among the Adult Population: New Insights...

To define the evolving role of serial transverse enteroplasty (STEP) in the surgical management of intestinal failure (IF) in patients with short bowel syndrome (SBS), especially among the adult population.

The current literature is lacking the rationale and long-term efficacy of STEP as a part of the multidisciplinary management of SBS-IF adult population.

The study included a total of 64 total parenteral nutrition-dependent patients. The causes of SBS were wide-ranging, with residual bowel length of 79 ± 47 cm and plasma citrulline level of 22 ± 12 umol/L. Partial or full colon was preserved in 56 (88%) patients. STEP was primary in 32 patients and integrated with autologous gut reconstruction in the remaining 32. Integrated STEP was technically feasible in 44% of the preoperative candidates. To assess the therapeutic benefits of integrated STEP, 32 of the contemporaneous autologous gut reconstruction-only patients were statistically identified by propensity-score matching as the control group.

With a mean follow-up of 35 ± 24 months, the 64 study patients received a total of 81 STEP procedures. The 5-year disease-specific survival was 91% with a respective restored enteral autonomy (EA) rate of 80%. Compared with the matched control, integrated STEP significantly ( P = 0.02) enhanced the cumulative restoration of EA. The American Society of Anesthesiologists comorbidity class IV was the only significant ( P = 0.05) survival risk factor. Preoperative total parenteral nutrition caloric requirements and total increment in bowel length were independent predictors of STEP-associated EA. Consequently, STEP was a significant predictor of restored EA among the overall SBS-IF patients.

This study underscores the wide applicability and long-term therapeutic efficacy of STEP among patients with SBS, including adults. Accordingly, the procedure should be increasingly utilized for all ages and promptly considered as an integral part of the SBS-IF management armamentarium.