Taking a STEP back: Assessing the outcomes of multiple STEP procedures

Infographic · Oct 2018 · 1 min read

In brief

Retrospective study of 24 STEP procedures in 17 children found that repeat STEP procedures (ReSTEPs) produced significantly smaller bowel length gains and failed to achieve enteral autonomy in any patient, compared to 18% weaning after initial STEP. Authors recommend careful patient selection before performing ReSTEPs given limited efficacy and higher costs.

First STEP procedures achieved 18% PN weaning rate vs 0% for repeat STEPs, with no ReSTEP patients reaching enteral autonomy
Initial STEP increased bowel length by 51% compared to only 20% gain with ReSTEP procedures (p=0.02)
Enteral nutrition tolerance improved 26% after first STEP but only 4.7% after ReSTEP (p=0.03)
Patient demographics and SBS etiology did not predict need for repeat STEP procedures
Given higher costs and limited efficacy, surgeons should carefully weigh risks/benefits before performing ReSTEP procedures

Written by the GCMD Library team from the infographic.

A clinical slide with teal header showing the Journal of Pediatric Surgery branding. The layout presents two columns comparing First STEPs (n=11) versus ReSTEP (n=6) procedures, with simple line drawings illustrating bowel lengthening patterns. Three outcome metrics are displayed in rows with orange arrow indicators highlighting significant differences. The color scheme uses teal, white, and orange accents on a muted green background.

Purpose

Short bowel syndrome (SBS) is a highly morbid condition primarily because of parenteral nutrition (PN)–associated complications. Bowel lengthening via serial transverse enteroplasty (STEP) has become standard of care. While initial STEPs have resulted in weaning from PN, outcomes of repeated STEPs (ReSTEPs) are not well described. We investigated outcomes of initial STEP compared to ReSTEP procedures.

Methods

This retrospective review of STEPs included 17 children and a total of 24 procedures. Demographics, complications, hospital readmission rates, postoperative costs, and PN weaning were analyzed.

Results

Neither patient-specific data nor the etiology of SBS was predictive of requiring a ReSTEP. PN weaning was more likely in the year following a first STEP (18% wean rate vs. 0% for ReSTEP, p > .05). No ReSTEP patients reached enteral autonomy. Enteral nutrition (%EN) increases were greater after first STEP compared to ReSTEP (26.0% vs. 4.7%, p = 0.03). This trend was true for bowel length as well, where first STEPs resulted in a 51% increase in bowel length compared to a 20% increase after in ReSTEP (p = 0.02).

Conclusions

ReSTEPs failed to result in significant PN weaning, with no ReSTEP patients achieving enteral autonomy during follow-up. Given its higher costs, smaller bowel length gains, and limited ability to produce enteral autonomy, surgeons should carefully consider performing ReSTEP procedures.

Level of evidence

Level III.

The text in the image

Taking a STEP back: Assessing the outcomes of multiple STEP procedures | Meredith Barrett Correspondence information about the author Meredith Barrett. | Farokh R. Demehri, Graham C. Ives, Kristen Schaedig, Meghan A. Arnold, Daniel H. Teitelbaum | Journal of Pediatric Surgery | First STEPs= 11 | ReSTEP = 6 | TPN weaning | 18% | 0% | p > .05 | Enteral nutrition | 26 % | 4.7% | p = 0.03 | Bowel length | 51% | 20% | p = 0.02 | ReSTEPs failed to provide significant positive impact on SBS patients. Surgeons should carefully consider performing ReSTEP procedures. | visual abstract created by Abulraouf Lamoshi

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