title: Improved tolerance for enteral nutrition after serial transverse enteroplasty (STEP) in infants and children with short bowel syndrome--a seven-year single-center experience.
abstract: BACKGROUND
  Serial transverse enteroplasty (STEP) was designed to lengthen and taper the small intestine in patients with short bowel syndrome (SBS) and dilated small bowel. We hypothesized that tolerance for enteral nutrition (EN) improves after STEP.
  
  
  METHODS
  Patients who underwent STEP between March 2004 and January 2011 were identified. Candidates for STEP had radiographic evidence of dilated small bowel and either failed to advance EN or demonstrated deterioration in tolerance for EN. Clinical and nutritional data were analyzed pre- and post-STEP. EN was defined as the percentage of calories administered enterally. Statistical analysis employed the signed rank test with significance assumed when p<0.05.
  
  
  RESULTS
  Twenty STEPs were performed at a median age of 13.7 months. Median pre-STEP bowel length was 30 cm with a median increase in bowel length of 42%. Five patients achieved enteral autonomy at a median of 6.5 months post-STEP. EN increased in 75%, while 25% exhibited unchanged or decreased EN post-STEP. In aggregate, median EN tolerance increased from 22% at one month pre-STEP to 61% at six months post-STEP (p=0.003).
  
  
  CONCLUSIONS
  The STEP is an effective adjunct in the treatment of patients with intestinal failure. While enteral autonomy is eventually possible in some patients, improved enteral tolerance can be achieved in a majority of cases.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Pilyung S
authors.initials: PS
authors.lastname: Oh
authors.affiliation: Division of Pediatric Surgery, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Abbey L
authors.initials: AL
authors.lastname: Fingeret
authors.affiliation: Gaming Laboratories International, LLC, Lakewood, NJ 08701, United States.
authors.forename: Manan Y
authors.initials: MY
authors.lastname: Shah
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Kara A
authors.initials: KA
authors.lastname: Ventura
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Brodlie
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ovchinsky
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Center for Liver Disease and Transplantation, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lobritto
authors.affiliation: Division of Pediatric Surgery, Department of Surgery Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, United States; Section of Pediatric Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, United States. Electronic address: robert.cowles@yale.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cowles
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery*; D016896:Treatment Outcome
keywords: Enteral; Enteroplasty; Intestinal lengthening; Intestinal rehabilitation; Parenteral; Short bowel syndrome