title: Improved enteral tolerance following step procedure: systematic literature review and meta-analysis.
abstract: Surgical management of children with short bowel syndrome (SBS) changed with the introduction of the serial transverse enteroplasty procedure (STEP). We conducted a systematic review and meta-analysis using MEDLINE and SCOPUS to determine if children with SBS had improved enteral tolerance following STEP. Studies were included if information about a child's pre- and post-STEP enteral tolerance was provided. A random effects meta-analysis provided a summary estimate of the proportion of children with enteral tolerance increase following STEP. From 766 abstracts, seven case series involving 86 children were included. Mean percent tolerance of enteral nutrition improved from 35.1 to 69.5. Sixteen children had no enteral improvement following STEP. A summary estimate showed that 87 % (95 % CI 77-95 %) of children who underwent STEP had an increase in enteral tolerance. Compilation of the literature supports the belief that SBS subjects' enteral tolerance improves following STEP. Enteral nutritional tolerance is a measure of efficacy of STEP and should be presented as a primary or secondary outcome. By standardizing data collection on children undergoing STEP procedure, better determination of nutritional benefit from STEP can be ascertained.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fernandes
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Usatin
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Rhee
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Benioff Children's Hospital, University of California, San Francisco, 550 16th Street 5th Floor, San Francisco, CA, 94143, USA. lan.vu@ucsf.edu.
authors.forename: Lan
authors.initials: L
authors.lastname: Vu
mesh_terms: D002648:Child; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery*; D016896:Treatment Outcome
keywords: Enteral nutrition; Meta-analysis; STEP; Serial transverse enteroplasty procedure; Short bowel, short gut