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

Abstract

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.

Comparing bowel lengthening procedures: which, when, and why?

“…Another variation on the STEP has been introduced, the modified STEP (MSTEP), where the mesenteric handling is avoided. This adjusted method has similar results to STEP, with 46% of patients achieving enteral autonomy and 19% surgical-related complications [25]. It has fewer contraindications, unlike the LILT procedure, which is for example not feasible in a very adhesive abdomen.…”

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

“…This technique can also be applied to the duodenum. The inventors reported this surgery to be at least as effective as the original STEP, with 5/11 (45%) patients achieving enteral autonomy [ 97 ]. Other modifications also report the possibility to lengthen the duodenum by the sequential transverse anterior and posterior application of an endoscopic stapler [ 98 ] (level of evidence: case series).…”