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Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome.
J Pediatr Surg. 2007 Nov; 42(11):1804-10.JP

Abstract

BACKGROUND

Serial transverse enteroplasty (STEP) is a novel intestinal lengthening procedure introduced in 2003. To date, no human studies exist that report objective assessment of intestinal absorptive capacity. The aim of this study was to report intermediate outcomes in patients who have received the STEP at our institution using clinical and biochemical assessment of intestinal function.

METHODS

All 14 patients who received the STEP since May 2003 were reviewed. Clinical (weight gain, enteral tolerance, stool frequency) and biochemical (citrulline levels, D-xylose absorption, alpha-1 antitrypsin clearance, and fecal fat content) outcomes were performed pre-STEP and post-STEP at 1, 6, and 12 months, respectively. Data are presented as means with standard deviation. Paired t tests were used to compare post-STEP outcomes with pre-STEP values (P < .05 was significant). Three patients had a STEP as a newborn and are analyzed separately.

MAIN RESULTS

There were 14 patients (3 females; mean age, 24.8 months; range, 1 day-14 years). Serial transverse enteroplasty resulted in a mean increase in length of dilated bowel segment of 94% +/- 30% and increase in total small bowel length of 49% +/- 42% with mean application of 16 +/- 9 cartridges and cost of Can$2878.51 +/- 1406.22. Patients demonstrated improvement in both clinical parameters, as well as intestinal absorptive function. Complications included 2 patients with staple line leak and 1 patient with gastrointestinal bleeding from staple line ulcers. Three patients died (2 from liver failure and 1 from sepsis and congenital heart disease). Two patients received liver-intestinal transplants at 4 and 5 months post-STEP. Mean follow-up was 23 +/- 9 months, with 7 patients followed more than 2 years. Of 8 patients with post-STEP follow-up of more than 1 year, 7 have weaned from parenteral nutrition.

CONCLUSION

Clinical and objective biochemical outcomes of intestinal function after the STEP procedure show promise after intermediate follow-up.

Authors+Show Affiliations

Division of General Surgery, The Hospital for Sick Children, Toronto, Canada M5G 1X8. paul.wales@sickkids.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18022427

Citation

Wales, Paul W., et al. "Intermediate Outcomes After Serial Transverse Enteroplasty in Children With Short Bowel Syndrome." Journal of Pediatric Surgery, vol. 42, no. 11, 2007, pp. 1804-10.
Wales PW, de Silva N, Langer JC, et al. Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome. J Pediatr Surg. 2007;42(11):1804-10.
Wales, P. W., de Silva, N., Langer, J. C., & Fecteau, A. (2007). Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome. Journal of Pediatric Surgery, 42(11), 1804-10.
Wales PW, et al. Intermediate Outcomes After Serial Transverse Enteroplasty in Children With Short Bowel Syndrome. J Pediatr Surg. 2007;42(11):1804-10. PubMed PMID: 18022427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome. AU - Wales,Paul W, AU - de Silva,Nicole, AU - Langer,Jacob C, AU - Fecteau,Annie, PY - 2007/11/21/pubmed PY - 2008/1/5/medline PY - 2007/11/21/entrez SP - 1804 EP - 10 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 42 IS - 11 N2 - BACKGROUND: Serial transverse enteroplasty (STEP) is a novel intestinal lengthening procedure introduced in 2003. To date, no human studies exist that report objective assessment of intestinal absorptive capacity. The aim of this study was to report intermediate outcomes in patients who have received the STEP at our institution using clinical and biochemical assessment of intestinal function. METHODS: All 14 patients who received the STEP since May 2003 were reviewed. Clinical (weight gain, enteral tolerance, stool frequency) and biochemical (citrulline levels, D-xylose absorption, alpha-1 antitrypsin clearance, and fecal fat content) outcomes were performed pre-STEP and post-STEP at 1, 6, and 12 months, respectively. Data are presented as means with standard deviation. Paired t tests were used to compare post-STEP outcomes with pre-STEP values (P < .05 was significant). Three patients had a STEP as a newborn and are analyzed separately. MAIN RESULTS: There were 14 patients (3 females; mean age, 24.8 months; range, 1 day-14 years). Serial transverse enteroplasty resulted in a mean increase in length of dilated bowel segment of 94% +/- 30% and increase in total small bowel length of 49% +/- 42% with mean application of 16 +/- 9 cartridges and cost of Can$2878.51 +/- 1406.22. Patients demonstrated improvement in both clinical parameters, as well as intestinal absorptive function. Complications included 2 patients with staple line leak and 1 patient with gastrointestinal bleeding from staple line ulcers. Three patients died (2 from liver failure and 1 from sepsis and congenital heart disease). Two patients received liver-intestinal transplants at 4 and 5 months post-STEP. Mean follow-up was 23 +/- 9 months, with 7 patients followed more than 2 years. Of 8 patients with post-STEP follow-up of more than 1 year, 7 have weaned from parenteral nutrition. CONCLUSION: Clinical and objective biochemical outcomes of intestinal function after the STEP procedure show promise after intermediate follow-up. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/18022427/Intermediate_outcomes_after_serial_transverse_enteroplasty_in_children_with_short_bowel_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(07)00486-1 DB - PRIME DP - Unbound Medicine ER -