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Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition.
J Pediatr. 2014 Jan; 164(1):93-8.JPed

Abstract

OBJECTIVE

To analyze the effects of serial transverse enteroplasty (STEP) on parenteral and enteral calories in children with short bowel syndrome, and examine short- and long-term complications.

STUDY DESIGN

A retrospective analysis of prospectively-collected data from a large single center cohort of patients undergoing STEP procedure was analyzed. Baseline demographic and clinical information, operative data, and short- and long-term complications were recorded. Detailed growth and nutritional data were obtained for 6 months prior and 12 months following STEP procedure.

RESULTS

Sixty-eight procedures were performed in 51 patients over a 68-month period. Median bowel length at first STEP was 51 cm with a median length gain of 54%. Repeat STEP patients had longer initial length (77 cm) and reduced length gain (20%). Operative times and blood loss were low, with few complications. Parenteral calorie requirement was stable or rising for 6 months prior to STEP, but decreased to median <20 kCal/kg/d at 1 year postop. Longer length gains were associated with higher risk of stricture formation. Seven children were transplanted, and 60% of nontransplanted children were enterally independent, with the remainder making ongoing progress; 48/51 children are alive at a median of 39 months follow-up.

CONCLUSIONS

STEP is shown to be safe, well tolerated, and to have definitive benefit in reducing parenteral calorie requirements over the first year following the procedure. It has an important role in achieving enteral independence in children with short bowel syndrome.

Authors+Show Affiliations

Department of Surgery, University of Nebraska Medical Center, Omaha, NE. Electronic address: dmercer@unmc.edu.Department of Clinical Nutrition, University of Nebraska Medical Center, Omaha, NE.Department of Surgery, University of Nebraska Medical Center, Omaha, NE.Department of Surgery, University of Nebraska Medical Center, Omaha, NE.Department of Surgery, University of Nebraska Medical Center, Omaha, NE.Department of Surgery, University of Nebraska Medical Center, Omaha, NE.Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24094877

Citation

Mercer, David F., et al. "Serial Transverse Enteroplasty Allows Children With Short Bowel to Wean From Parenteral Nutrition." The Journal of Pediatrics, vol. 164, no. 1, 2014, pp. 93-8.
Mercer DF, Hobson BD, Gerhardt BK, et al. Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition. J Pediatr. 2014;164(1):93-8.
Mercer, D. F., Hobson, B. D., Gerhardt, B. K., Grant, W. J., Vargas, L. M., Langnas, A. N., & Quiros-Tejeira, R. E. (2014). Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition. The Journal of Pediatrics, 164(1), 93-8. https://doi.org/10.1016/j.jpeds.2013.08.039
Mercer DF, et al. Serial Transverse Enteroplasty Allows Children With Short Bowel to Wean From Parenteral Nutrition. J Pediatr. 2014;164(1):93-8. PubMed PMID: 24094877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition. AU - Mercer,David F, AU - Hobson,Brandy D, AU - Gerhardt,Brandi K, AU - Grant,Wendy J, AU - Vargas,Luciano M, AU - Langnas,Alan N, AU - Quiros-Tejeira,Ruben E, Y1 - 2013/10/01/ PY - 2013/05/16/received PY - 2013/07/30/revised PY - 2013/08/20/accepted PY - 2013/10/8/entrez PY - 2013/10/8/pubmed PY - 2014/2/19/medline KW - IRP KW - IV KW - Intestinal rehabilitation program KW - Intravenous KW - NEC KW - Necrotizing enterocolitis KW - PN KW - Parenteral nutrition KW - STEP KW - Serial transverse enteroplasty KW - TPN KW - Total parenteral nutrition SP - 93 EP - 8 JF - The Journal of pediatrics JO - J Pediatr VL - 164 IS - 1 N2 - OBJECTIVE: To analyze the effects of serial transverse enteroplasty (STEP) on parenteral and enteral calories in children with short bowel syndrome, and examine short- and long-term complications. STUDY DESIGN: A retrospective analysis of prospectively-collected data from a large single center cohort of patients undergoing STEP procedure was analyzed. Baseline demographic and clinical information, operative data, and short- and long-term complications were recorded. Detailed growth and nutritional data were obtained for 6 months prior and 12 months following STEP procedure. RESULTS: Sixty-eight procedures were performed in 51 patients over a 68-month period. Median bowel length at first STEP was 51 cm with a median length gain of 54%. Repeat STEP patients had longer initial length (77 cm) and reduced length gain (20%). Operative times and blood loss were low, with few complications. Parenteral calorie requirement was stable or rising for 6 months prior to STEP, but decreased to median <20 kCal/kg/d at 1 year postop. Longer length gains were associated with higher risk of stricture formation. Seven children were transplanted, and 60% of nontransplanted children were enterally independent, with the remainder making ongoing progress; 48/51 children are alive at a median of 39 months follow-up. CONCLUSIONS: STEP is shown to be safe, well tolerated, and to have definitive benefit in reducing parenteral calorie requirements over the first year following the procedure. It has an important role in achieving enteral independence in children with short bowel syndrome. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/24094877/Serial_transverse_enteroplasty_allows_children_with_short_bowel_to_wean_from_parenteral_nutrition_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(13)01067-6 DB - PRIME DP - Unbound Medicine ER -