Repeat serial transverse enteroplasty leads to reduction in parenteral nutrition in children with short bowel syndrome
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In brief
In brief
Retrospective study of 23 pediatric patients who underwent repeat serial transverse enteroplasty (2STEP) for intestinal redilation after initial STEP procedure. Results showed significant reduction in parenteral nutrition dependence at long-term follow-up, with 13 patients achieving complete independence from parenteral support, supporting 2STEP as a viable option for selected patients with short bowel syndrome.
Written by the GCMD Library team from the article.
Abstract
Background/purpose
Following a serial transverse enteroplasty (STEP) procedure some children develop redilation of the small intestine leading to impaired enteral tolerance and inability to wean parenteral nutrition (PN). The benefit of a second STEP procedure (2STEP) has been controversial.
Methods
We performed a retrospective review of our experience (2008–2018) performing 2STEP, with comparative analysis of nutritional outcomes pre- and postsurgery.
Results
During this period 2STEP was performed in 23 patients (13 F:10 M) at a median (25%–75%) age of 2.2 (1.2–3.6) years. Median intestinal length was 68 (40–105) cm before and 85 (40–128) cm after 2STEP. Leading up to 2STEP, PN provided almost 75% of estimated calorie needs. By 24 weeks following 2STEP drops in mean PN percent approached statistical significance (p = 0.07) and at most recent follow up the mean PN percentage was statistically better than at the time of operation or 4 weeks prior to 2STEP, and was nearly significant compared with 12 weeks (p = 0.07) and 24 weeks (p = 0.06) prior. Thirteen children were completely off parenteral support.
Conclusion
When small intestine redilation occurs following a STEP procedure and where PN cannot otherwise be weaned we believe these data support performing a 2STEP. We cannot predict preoperatively which children will ultimately benefit.
Level of evidence
3 (retrospective comparative study).