STEP improves long-term survival for pediatric short bowel syndrome patients: A Markov decision analysis

Choudhury, Rashikh A.; Yoeli, Dor; Hoeltzel, Gerard D.; Moore, Hunter B.; Prins, Kas; Kovler, Mark L.; Goldstein, Seth D.; Holland-Cunz, Stephan G.; Adams, Megan; Roach, Jonathan P.; Nydam, Trevor L.; Vuille‐dit‐Bille, Raphael N.

doi:10.1016/j.jpedsurg.2020.03.017

Cited by 10 publications

(11 citation statements)

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“…Intestinal failure reflects the reduction in functional small bowel below the minimum necessary for digestion and absorption to maintain growth in children and/or homeostasis in children and adults. The most common etiology is short bowel syndrome (SBS), which describes a reduction in anatomical and functional bowel length [ 64 , 65 , 66 , 67 ]. Several diseases of the gastrointestinal tract, including necrotizing enterocolitis (NEC), intestinal atresia [ 68 ], midgut volvulus, and long-segment Hirschsprungs’ disease in children, as well as mesenteric ischemia, Crohn’s disease, and irradiation in adults [ 65 ], may lead to extensive damage and/or intestinal resections ending in SBS [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients with chronic intestinal failure can be dependent on long-term parenteral nutrition with its inherent morbidity and mortality, including (repeated) catheter-associated sepsis, cirrhosis, and liver failure [ 69 ]. While many factors seem to play a role, the length of the remnant intestine and the type of digestive anastomosis reflects a major determinant of patient survival and nutritional prognosis [ 67 , 70 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

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Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use

et al. 2021

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L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use

et al. 2021

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“…As mentioned, STEP can be performed after other intestinal lengthening procedures and has even been done multiple times on the same patients, however with varying success rates [ 6 , 10 , 11 ]. An interesting study shows a simulation model that concludes that STEP was associated with an increased rate of enteral autonomy compared to transplantation (no STEP beforehand) and that transplantational rates were reduced by STEP [ 12 ]. It also has a long-lasting influence on bacterial overgrowth and D-lactic acidosis [ 13 ].…”

Section: Serial Transverse Enteroplastymentioning

confidence: 99%

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

Praagh

Hofker

Haveman

2022

Current Opinion in Organ Transplantation

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Purpose of reviewIntestinal failure secondary to short bowel syndrome is still a very serious condition. Treatment consists of parenteral nutrition to provide nutrients and maintain body weight. During the last decades, intestinal lengthening procedures have become more available. The goal of this review is to discuss the results of the literature on the most commonly performed intestinal lengthening procedures.Recent findingsLongitudinal Intestinal Lengthening, Serial Transverse Enteroplasty (STEP), and Spiral Intestinal Lengthening and Tailoring (SILT) are currently the most frequently reported intestinal lengthening procedures. The most recent literature of these procedures is described with respect to indication, technical details, complications, short and long-term outcome, and PN independence.SummaryOn the basis of indication, surgical complexity, complications, and clinical success, we conclude that the STEP procedure is probably the best choice for most centers.

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“…A recently published Markov decision (with a level of evidence of III) reports that STEP has positive effects on enteral autonomy and long-term survival, as well as a reduction in the need for intestinal transplantation [ 96 ]. One of the most recent published studies in 36 patients operated on using STEP reports a median increase in bowel length of 53%, and 42% of patients regaining enteral autonomy [ 94 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

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

et al. 2022

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Short bowel syndrome (SBS) is a devastating disorder with both short- and long-term implications for patients. Unfortunately, the prevalence of SBS has doubled over the past 40 years. Broadly speaking, the etiology of SBS can be categorized as congenital or secondary, the latter typically due to extensive small bowel resection following diseases of the small intestine, e.g., necrotizing enterocolitis, Hirschsprung’s disease or intestinal atresia. As of yet, no cure exists, thus, conservative treatment, primarily parenteral nutrition (PN), is the first-line therapy. In some cases, weaning from PN is not possible and operative therapy is required. The invention of the longitudinal intestinal lengthening and tailoring (LILT or Bianchi) procedure in 1980 was a major step forward in patient care and spawned further techniques that continue to improve lives for patients with severe SBS (e.g., double barrel enteroplasty, serial transverse enteroplasty, etc.). With this review, we aim to provide an overview of the clinical implications of SBS, common conservative therapies and the development of operative techniques over the past six decades. We also provide a short outlook on the future of operative techniques, specifically with respect to regenerative medicine.

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STEP improves long-term survival for pediatric short bowel syndrome patients: A Markov decision analysis

Cited by 10 publications

References 45 publications

Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use

Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use

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

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

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