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The impact of longitudinal intestinal lengthening and tailoring on liver function in short bowel syndrome.
Eur J Pediatr Surg. 2008 Aug; 18(4):249-53.EJ

Abstract

INTRODUCTION

Short bowel syndrome is a functional or anatomic loss of major parts of the small bowel leading to severe malnutrition. The limiting factor for the survival of these patients remains parenteral nutrition-related liver damage leading to end-stage liver failure. Longitudinal intestinal lengthening and tailoring (LILT) has been proven to enhance peristalsis, to decrease bacterial overgrowth and to extend the mucosal contact time for the absorption of nutrients. The aim of this study was to show the impact of LILT on the development of parenteral nutrition-related liver damage.

PATIENTS AND METHODS

A cohort of 55 patients with short bowel syndrome managed with LILT in our institution between 1987 and 2007 was retrospectively reviewed. LILT was performed at a mean age of 24 months (range 4 - 150 months). Mean follow-up time was 83.76 months (range 5 - 240 months). We obtained reliable data from 31 patients with regard to liver enzymes and function parameters in blood samples before LILT and at the present time. Liver biopsy was performed in 14 patients prior to LILT.

RESULTS

Liver enzymes ALAT (mean 121 U/l), ASAT (mean 166 U/l) and bilirubin (mean 2.49 mg/dl) were elevated preoperatively in 27/31 children. After the lengthening procedure, ALAT (mean 50 U/l), ASAT (mean 63 U/l) and bilirubin (mean 1.059 mg/dl) normalized except in 5 of 8 patients who could not be weaned from parenteral nutrition after LILT. Liver function parameters such as the international normal ratio (INR) were slightly elevated in 5/31 patients. Albumin was generally low, probably due to parenteral nutrition. Liver biopsy was performed in 14 patients preoperatively, showing 4 patients with low-grade, 6 patients with intermediate and 4 patients with high-grade fibrosis. End-stage liver disease with cirrhosis was an exclusion criterion for LILT. All patients with liver fibrosis showed a normalization of liver enzymes when they were weaned from parenteral nutrition. But patients with higher grade liver fibrosis tend to develop more complications perioperatively.

CONCLUSION

After LILT, all patients with liver fibrosis who could be weaned from parenteral nutrition showed a normalization of liver enzymes. Preoperative liver biopsy is mandatory in order to differentiate reversible liver fibrosis from end-stage liver disease. A higher grade of liver fibrosis and elevated INR has been shown to be a sensitive parameter for peri- and postoperative complications.

Authors+Show Affiliations

Department of Pediatric Surgery, University Hospital Mannheim, Heidelberg University, Germany. konrad.reinshagen@kch.ma.uni-heidelberg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18704888

Citation

Reinshagen, K, et al. "The Impact of Longitudinal Intestinal Lengthening and Tailoring On Liver Function in Short Bowel Syndrome." European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Fur Kinderchirurgie, vol. 18, no. 4, 2008, pp. 249-53.
Reinshagen K, Zahn K, Buch Cv, et al. The impact of longitudinal intestinal lengthening and tailoring on liver function in short bowel syndrome. Eur J Pediatr Surg. 2008;18(4):249-53.
Reinshagen, K., Zahn, K., Buch, C. v., Zoeller, M., Hagl, C. I., Ali, M., & Waag, K. L. (2008). The impact of longitudinal intestinal lengthening and tailoring on liver function in short bowel syndrome. European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Fur Kinderchirurgie, 18(4), 249-53. https://doi.org/10.1055/s-2008-1038645
Reinshagen K, et al. The Impact of Longitudinal Intestinal Lengthening and Tailoring On Liver Function in Short Bowel Syndrome. Eur J Pediatr Surg. 2008;18(4):249-53. PubMed PMID: 18704888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of longitudinal intestinal lengthening and tailoring on liver function in short bowel syndrome. AU - Reinshagen,K, AU - Zahn,K, AU - Buch,C von, AU - Zoeller,M, AU - Hagl,C I, AU - Ali,M, AU - Waag,K-L, Y1 - 2008/08/14/ PY - 2008/8/16/pubmed PY - 2008/12/17/medline PY - 2008/8/16/entrez SP - 249 EP - 53 JF - European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie JO - Eur J Pediatr Surg VL - 18 IS - 4 N2 - INTRODUCTION: Short bowel syndrome is a functional or anatomic loss of major parts of the small bowel leading to severe malnutrition. The limiting factor for the survival of these patients remains parenteral nutrition-related liver damage leading to end-stage liver failure. Longitudinal intestinal lengthening and tailoring (LILT) has been proven to enhance peristalsis, to decrease bacterial overgrowth and to extend the mucosal contact time for the absorption of nutrients. The aim of this study was to show the impact of LILT on the development of parenteral nutrition-related liver damage. PATIENTS AND METHODS: A cohort of 55 patients with short bowel syndrome managed with LILT in our institution between 1987 and 2007 was retrospectively reviewed. LILT was performed at a mean age of 24 months (range 4 - 150 months). Mean follow-up time was 83.76 months (range 5 - 240 months). We obtained reliable data from 31 patients with regard to liver enzymes and function parameters in blood samples before LILT and at the present time. Liver biopsy was performed in 14 patients prior to LILT. RESULTS: Liver enzymes ALAT (mean 121 U/l), ASAT (mean 166 U/l) and bilirubin (mean 2.49 mg/dl) were elevated preoperatively in 27/31 children. After the lengthening procedure, ALAT (mean 50 U/l), ASAT (mean 63 U/l) and bilirubin (mean 1.059 mg/dl) normalized except in 5 of 8 patients who could not be weaned from parenteral nutrition after LILT. Liver function parameters such as the international normal ratio (INR) were slightly elevated in 5/31 patients. Albumin was generally low, probably due to parenteral nutrition. Liver biopsy was performed in 14 patients preoperatively, showing 4 patients with low-grade, 6 patients with intermediate and 4 patients with high-grade fibrosis. End-stage liver disease with cirrhosis was an exclusion criterion for LILT. All patients with liver fibrosis showed a normalization of liver enzymes when they were weaned from parenteral nutrition. But patients with higher grade liver fibrosis tend to develop more complications perioperatively. CONCLUSION: After LILT, all patients with liver fibrosis who could be weaned from parenteral nutrition showed a normalization of liver enzymes. Preoperative liver biopsy is mandatory in order to differentiate reversible liver fibrosis from end-stage liver disease. A higher grade of liver fibrosis and elevated INR has been shown to be a sensitive parameter for peri- and postoperative complications. SN - 0939-7248 UR - https://www.unboundmedicine.com/medline/citation/18704888/The_impact_of_longitudinal_intestinal_lengthening_and_tailoring_on_liver_function_in_short_bowel_syndrome_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2008-1038645 DB - PRIME DP - Unbound Medicine ER -