Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report

Bueno, Javier; Burgos, R.; Redecillas, Susana; López, Manuel; Balsells, J.

doi:10.17235/reed.2017.5187/2017

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…SBS is mainly, but not only, a matter of length. In children, the massive resection of the small bowel could lead to a “very short bowel syndrome” (≤ 40 cm)[ 13 , 14 ], “ultra-short bowel syndrome” (between < 30 and < 10 cm)[ 15 - 17 ] or “no gut syndrome” (only the duodenum is left)[ 18 - 20 ]. Adults with less than 200 cm but more than 75 cm of small bowel[ 21 ] have a potentially functional intestine especially if the colon (and specifically the ileocolic valve) is preserved in continuity.…”

Section: Overview Of the Literaturementioning

confidence: 99%

“…The surgical rescue of “no gut” syndrome has been reported in adults as well. Bueno et al[ 20 ] demonstrated the feasibility of lengthening a dilated duodenum in a patient where his mega-duodenal stump was tapered by STEP, restoring his digestive continuity through an end-to-side duodeno-colonic anastomosis. After 24 mo of follow-up, the time on daily PN was shortened from 24 to 9 h and the volume and calorie requirements were reduced by half.…”

Section: Surgeon’s Perspectivementioning

confidence: 99%

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Surgeon’s perspective on short bowel syndrome: Where are we?

Marino¹,

Lauro²

2018

WJT

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Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented by the residual length of the small bowel where ileum has shown increased adaptive function than jejunum, but colon should be considered because of its importance in the digestive process. These concepts have been translated also in intestinal transplantation, where a colonic graft is nowadays widely used and the terminal ileum is the selected segment for a living-related donation. The whole replacement by a bowel or multivisceral transplant is still affected by poor long term outcome and must be reserved to a select population of SBS patients, affected by intestinal failure associated with irreversible complications of parenteral nutrition.

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Section: Overview Of the Literaturementioning

confidence: 99%

Section: Surgeon’s Perspectivementioning

confidence: 99%

Surgeon’s perspective on short bowel syndrome: Where are we?

Marino¹,

Lauro²

2018

WJT

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“…4 Thus, in cases of associated duodenal dilatation, we were able to apply the same principles to the duodenum gaining an additional length and tapering the duodenal diameter. 4,5 The aim of this study is to describe the results of children with SBS treated with the MSTEP at our institution, associated or not to duodenal lengthening with at least 1 year follow-up.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Children with Short Bowel Syndrome Treated with a Modification of the STEP Technique Avoiding Mesenteric Defect

et al. 2021

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Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with < 50% of colon achieved enteral autonomy (p < 0.05). After redo procedures, three of four attained enteral autonomy. Thus, 8 of 11 (73%) progressed to enteral autonomy, including all with duodenal lengthening. One child, already parenteral nutrition free, died due to central line sepsis. All the patients from the bacterial translocation group improved their metabolic/nutritional status, but one required subsequent enterectomy of the lengthened intestine due to multiple ulcers in the staple lines. Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

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