Report of 111 Consecutive Patients Enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: A Retrospective Observational Study

Abstract

Background The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors significantly associated with 1) transplantation or death, or 2) attainment of enteral autonomy following STEP. Study Design Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine predictors of transplantation/death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died, and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = .05 and p < .001, respectively). Of the 78 patients who were ≥7 days of age and required parenteral nutrition (PN) at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = .002). The median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI: 12-30). Conclusions Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.

Short-Bowel Syndrome in Children — An Update in Management Strategies

“…STEP 14.3%. Similar results were reported in a retrospective study by Jones et al [58] who pooled data from the International STEP Data Registry involving the long-term follow-up of 97 patients, aged 2.4 months to 37.8 months, who had undergone STEP. An overall mortality of 11% was recorded.…”

Absent ileocecal valve predicts the need for repeated step in children

“…It has been reported that 33-88% of patients can be weaned off parenteral support after STEP. 4,[8][9][10][11][12][13][14][15] The patients who had undergone repeated STEP had a similar chance to be weaned off parenteral support compared with those who underwent only one STEP supporting active operative approach to redilatation. There were no significant differences between weight and height z scores before STEP and at follow-up.…”

Competing risk bias was common in Kaplan–Meier risk estimates published in prominent medical journals

“…We designed this study to determine the 19 prevalence of competing risk bias in Kaplan-Meier analyses in studies published in prominent 20 medical journals and the potential magnitude of over-estimated risks caused by competing risk 21 bias. 22 23 METHODS: 24 We searched the MEDLINE database using the search strategy in Appendix A to identify 25 all human studies with abstracts that conducted a Kaplan-Meier analysis that were published in restriction would focus on studies published in well-known journals that are most likely to be 1 read by clinicians. All citations identified by the search were downloaded to a spreadsheet 2 program and then randomly sorted.…”