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Characteristics and clinical outcomes of pediatric patients following massive bowel resection: A retrospective cohort
Clarelle L Gonsalves1,2, Christina Belza1,2, Glenda Courtney-Martin1,3,4
1Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric patients with massive bowel resection (MBR) show improved outcomes with advancements in care. Achieving enteral autonomy is linked to greater residual bowel length and colon, and specific surgical interventions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Intestinal Rehabilitation
Background:
- Massive bowel resection (MBR), defined as <25% expected residual small bowel length, is rare in children.
- Traditionally associated with higher mortality and lower enteral autonomy rates.
- This study investigates characteristics and outcomes of pediatric MBR patients.
Purpose of the Study:
- Determine characteristics and clinical outcomes of pediatric patients following MBR.
- Compare patients achieving enteral autonomy versus those dependent on parenteral nutrition (PN).
- Identify factors associated with PN independence post-MBR.
Main Methods:
- Retrospective cohort study.
- Included pediatric patients managed by an intestinal rehabilitation program (2006-2017).
- Observation period extended to 2021.
Main Results:
- 61 MBR patients analyzed; 34.4% achieved enteral autonomy.
- Autonomy group had more residual small bowel (22% vs 13%) and full colon (100% vs 50%).
- Higher rates of ICV (73.2% vs 15%) and lower STEP procedures (14.3% vs 37.5%) in autonomy group.
Conclusions:
- Advancements in the last two decades have improved outcomes for MBR patients.
- More patients are reaching adaptive potential and mitigating prolonged PN complications.
- Overall outcomes are more favorable than previously reported.
Background:
Massive bowel resection (MBR), defined as residual small bowel < 25 % of expected length-for-age based on established norms, is a rare entity. Traditionally, children who have undergone MBR have higher mortality and less probability of achieving enteral autonomy compared to patients with less substantial bowel loss. The primary objective of this study was to determine the characteristics and clinical outcomes of pediatric patients following MBR. Secondary objectives included comparing patients who achieved enteral autonomy to those who remained parenteral nutrition (PN)-dependent to determine characteristics associated with PN independence.
Methods:
Retrospective cohort study of patients following MBR managed by our multidisciplinary intestinal rehabilitation program between January 1, 2006 and December 31, 2017, with an observation period ending December 31, 2021.
Results:
61 patients with MBR fulfilled study inclusion criteria. 21 patients (34.4 %) achieved enteral autonomy while 40 patients (65.6 %) did not. Patients who achieved enteral autonomy had a greater percentage of residual small bowel (22 % vs 13 %, P < 0.01) and colon (100 % vs 50 %, P < 0.01). They were more likely to have an ICV (73.2 % vs 15 %, P < 0.01) and less likely to undergo STEP procedure (14.3 % vs 37.5 %, P = 0.02). 18 patients in the cohort without enteral autonomy achieved greater than 50 % enteral nutrition. In this cohort, the overall transplant rate was 9.8 % and mortality rate was 11.5 %.
Conclusion:
Several important advancements have occurred over the last two decades that have allowed more patients to reach their adaptive potential and mitigate complications of prolonged PN following MBR. Overall outcomes are better than previously reported.
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