Serial transverse enteroplasty (STEP): intermediate outcomes in children with short bowel syndrome

Abstract

Short bowel syndrome is the most common cause of intestinal failure in children. The treatment is based on a multidisciplinary approach involving pediatricians, pediatric surgeons, and nutritionists. Surgical procedures for intestinal lengthening may be decisive, having been revalued after the recent description of serial transverse enteroplasty (STEP). We reviewed the patients who underwent the STEP operation for short bowel syndrome in our hospital in order to evaluate medium-term outcome. Between April 2006 and December 2008, three children were submitted to STEP without postoperative complications directly related to the procedure. In two cases the autonomy for oral/enteric feeding was obtained within 3 and 7 months after surgery with sustained growth, persisting at 5 years of follow-up after STEP. One child remained dependent of parenteral nutrition and was submitted to intestinal transplantation 30 months after STEP. However, since STEP until transplantation, it was possible to increase enteric volume and decrease intestinal dilation and the frequency of occlusive episodes. STEP is an effective and safe technique for intestinal lengthening that may allow increased tolerance to oral/enteric feeding or at least alleviate some complications of short bowel syndrome.

Gastrointestinal bleeding as a complication of serial transverse enteroplasty

“…Serial transverse enteroplasty (STEP), first described in 2003 1,2 , is now performed internationally 3–5 and is the most commonly utilized operation for intestinal reconstruction. 6 Forty-seven percent of patients achieve enteral autonomy after STEP.…”

To Wean or Not to Wean: The Role of Autologous Reconstructive Surgery in the Natural History of Pediatric Short Bowel Syndrome on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP)

“…Overall intestinal adaptation ranged from 6% [ 46 ] to 87% [ 56 ] at the final evaluation. STEP and LILT procedures elongated the bowel up to 75% and 100%, respectively, both requiring adequate bowel dilation and fresh and scar-free mesentery to allow for extensive intestinal handling [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ].…”

“…The chance to be weaned off PN following STEP and LILT procedures ranged from6% [ 46 ] to 67% [ 59 ] and from 55.5% [ 45 ] to 100% [ 56 ], respectively. Only 11 studies assessed the development of LD that ranged from 2.7% [ 44 ] to 67% [ 59 ]; however, LD was considered as an indication of AGIR in many studies and not as a complication. Furthermore, 4.5% [ 45 ] to 33% [ 59 ] underwent transplantation.…”

“…The papers included [ 21 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ] were subdivided into two groups according to the treatment. Therefore, references [ 21 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] included patients treated with PN alone or series in which less than 10% of patients were treated with combined PN and AGIR (Group 1).…”

“…Therefore, references [ 21 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] included patients treated with PN alone or series in which less than 10% of patients were treated with combined PN and AGIR (Group 1). References [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ] reported the trend of patients all treated with combined PN and AGIR (Group 2).…”