Long-term nutritional and clinical outcomes after serial transverse enteroplasty at a single institution

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Abstract

Purpose

Serial transverse enteroplasty (STEP) is a novel technique to lengthen and taper bowel in patients with intestinal failure. First described in 2003, initial data and reports have demonstrated favorable short-term outcomes, but there is limited published data on long-term outcomes of the procedure. Our aim was to assess clinical and nutritional outcomes after the STEP procedure.

Methods

After obtaining institutional review board approval, we reviewed all records of patients (n = 16) who underwent the STEP procedure at our institution from February 2002 to February 2008. Patients were observed for a median time of 23 months (range, 1-71) postoperatively. Analyses of z scores for weight, height, and weight-for-height, and progression of enteral calories were performed using longitudinal linear models with random effects.

Results

Of the 16 patients (10 male), the median age at time of surgery was 12 months (interquartile range, 1.5-65.0). The mean increase in bowel length was 91% ± 38%. After the STEP procedure, patients had increased weight-for-age z scores of 0.03 units per month (P = .0001), height for age z scores of 0.02 units per month (P = .004), and weight-for-height z scores of 0.04 units per month (P = .02). Patients had improved enteral tolerance of 1.4% per month (P < .0001). Six patients (38%) transitioned off parenteral nutrition (median, 248 days). Long-term complications included catheter-related bacteremia (n = 5), gastrointestinal bleeding (n = 3), and small bowel obstruction (n = 1). Two patients ultimately underwent transplantation. There were no deaths.

Conclusions

In pediatric patients with intestinal failure, the STEP procedure improves enteral tolerance, results in significant catch-up growth, and is not associated with increased mortality.

Section snippets

Methods

After obtaining institutional review board approval, we reviewed the charts and medical records of all patients who underwent the STEP procedure at our institution from February 2002 to February 2008. The mean follow-up period was 23 months (range, 1-71 months). We estimated mean postoperative trajectories of the 16 patients' z scores for weight, height, and weight-for-height, as well as their percentage of enteral calories. These trajectories were measured as a function of time using a linear

Results

Of the 16 patients (10 male), the median age at time of surgery was 12 months (interquartile range, 1.5-65.0). The most common indication for the STEP procedure was failure to advance on enteral feeds (Table 1). Other indications included complications arising from bacterial overgrowth and the desire to lengthen and taper selected neonatal intestinal atresias with marginal residual intestine length. As seen in Table 2, there was a mean increase in bowel length of 91% (SD, 38%) and a mean

Discussion

The STEP procedure has become an increasingly used technique in the surgical management of intestinal failure since its first description 5 years ago. This is in large part because of the technical ease and the broader applicability of the procedure compared to other methods of AIRS. There are already several reports from various centers demonstrating excellent short and intermediate-term results, including efficacy in lengthening and tapering intestine, improving enteral tolerance, and

Conclusions

Because the STEP procedure is a novel technique, there are limited reports of its long-term nutritional and clinical outcomes. To date, the longest reported follow-up of patients after STEP is less than 2 years [10], [11], [12]. In long-term follow-up of our patients of up to 5 years, we have had a relatively low rate of complications, including no deaths. We believe that with proper patient selection and ongoing intensive intestinal rehabilitation management, patients undergoing the STEP

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Presented at the 40th Annual CAPS Meeting, August 21-24, 2008, Toronto, Ontario, Canada.

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