title: Bowel re-dilation following serial transverse enteroplasty (STEP).
abstract: OBJECTIVE
  The serial transverse enteroplasty (STEP) operation tapers and lengthens dilated small bowel. Some patients demonstrate bowel re-dilation following STEP. Factors associated with bowel re-dilation and its effect upon clinical outcome were evaluated.
  
  
  METHODS
  Twenty STEP operations were reviewed. Sixteen cases were operated for failure to advance enteral feeding and were further analyzed. Available pre- and post-STEP radiographs were independently assessed for bowel re-dilation by two experienced pediatric radiologists. Potential factors of re-dilation were evaluated. Full enteral autonomy was defined as no longer requiring parenteral nutrition (PN) and remaining off PN for at least 12 months after STEP.
  
  
  RESULTS
  There was complete concordance between the radiologists. 9 of 16 patients demonstrated radiographic bowel re-dilation following STEP. Age, follow-up duration, time interval between STEP and last imaging reviewed, gender, diagnoses, pre- and post-STEP bowel length and width were not significantly associated with re-dilation. However, median post-STEP duration of PN was significantly longer in the re-dilated group than in the non-dilated group (41 vs. 3 months, p = 0.006). In addition, only 1 of 9 re-dilated patients achieved enteral autonomy as compared with 6 of 7 non-dilated patients (p = 0.009).
  
  
  CONCLUSIONS
  Longer PN duration after STEP increases probability of bowel re-dilation. Patients who re-dilated following STEP are significantly less likely to achieve enteral autonomy. Larger prospective data collections are warranted to further explore these relationships.
authors.affiliation: Department of Surgery, Center of Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA. horng.kang@gmail.com
authors.forename: Kuang Horng-Jamie
authors.initials: KH
authors.lastname: Kang
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Gutierrez
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Stephanie
authors.initials: S
authors.lastname: Diperna
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonomo
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D008297:Male; D012008:Recurrence; D012778:Short Bowel Syndrome / Q000601:surgery*