Long-term nutritional and clinical outcomes after serial transverse enteroplasty at a single institution.
OBJECTIVE
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.
Center for Advanced Intestinal Rehabilitation, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Y Avery
YA
Ching
Shimae
S
Fitzgibbons
Clarissa
C
Valim
Jing
J
Zhou
Christopher
C
Duggan
Tom
T
Jaksic
Heung Bae
HB
Kim
D002675:Child, Preschool; D003092:Colitis / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D004750:Enteral Nutrition; D004751:Enteritis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007409:Intestinal Atresia / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery; D016896:Treatment Outcome