Pediatric Surgery International

, Volume 28, Issue 12, pp 1189–1193 | Cite as

Bowel re-dilation following serial transverse enteroplasty (STEP)

  • Kuang Horng-Jamie Kang
  • Ivan M. Gutierrez
  • David Zurakowski
  • Stephanie DiPerna
  • Carlo Buonomo
  • Heung Bae Kim
  • Tom Jaksic
Original Article

Abstract

Purpose

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).

Conclusion

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.

Keywords

STEP Bowel re-dilation Bowel lengthening and tapering Short bowel syndrome Intestinal failure 

References

  1. 1.
    Casey L, Lee KH, Rosychuk R et al (2008) 10-year review of pediatric intestinal failure: clinical factors associated with outcome. Nutr Clin Pract 23:436–442PubMedCrossRefGoogle Scholar
  2. 2.
    Javid PJ, Malone FR, Reyes J et al (2010) The experience of a regional pediatric intestinal failure program: successful outcomes from intestinal rehabilitation. Am J Surg 199:676–679PubMedCrossRefGoogle Scholar
  3. 3.
    McDuffie LA, Bucher BT, Erwin CR et al (2011) Intestinal adaptation after small bowel resection in human infants. J Pediatr Surg 46:1045–1051PubMedCrossRefGoogle Scholar
  4. 4.
    O’Brien DP, Nelson LA, Huang FS et al (2001) Intestinal adaptation: structure, function, and regulation. Semin Pediatr Surg 10:56–64PubMedCrossRefGoogle Scholar
  5. 5.
    Modi BP, Javid PJ, Jaksic T et al (2007) First report of the international serial transverse enteroplasty data registry: indications, efficacy, and complications. J Am Coll Surg 204:365–371PubMedCrossRefGoogle Scholar
  6. 6.
    Miyasaka EA, Brown PI, Teitelbaum DH (2011) Redilation of bowel after intestinal lengthening procedures–an indicator for poor outcome. J Pediatr Surg 46:145–149PubMedCrossRefGoogle Scholar
  7. 7.
    Motulsky H (2010) Intuitive biostatistics: a nonmathematical guide to statistical thinking, 2nd edn. Oxford University Press, New York, pp 344–350Google Scholar
  8. 8.
    Katz M (2011) Multivariable analysis: a practical guide for clinicians and public health researchers, 3rd edn. Cambridge University Press, New York, pp 21–60CrossRefGoogle Scholar
  9. 9.
    Wales PW, de Silva N, Langer JC et al (2007) Intermediate outcomes after serial transverse enteroplasty in children with short bowel syndrome. J Pediatr Surg 42:1804–1810PubMedCrossRefGoogle Scholar
  10. 10.
    Modi BP, Ching YA, Langer M et al (2009) Preservation of intestinal motility after the serial transverse enteroplasty procedure in a large animal model of short bowel syndrome. J Pediatr Surg 44:229–235PubMedCrossRefGoogle Scholar
  11. 11.
    Chang RW, Javid PJ, Oh JT et al (2006) Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome. Ann Surg 243:223–228PubMedCrossRefGoogle Scholar
  12. 12.
    Kaji T, Tanaka H, Wallace LE et al (2009) Nutritional effects of the STEP procedure in experimental short bowel syndrome. J Pediatr Surg 44:1552–1559PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Kuang Horng-Jamie Kang
    • 1
  • Ivan M. Gutierrez
    • 1
  • David Zurakowski
    • 2
  • Stephanie DiPerna
    • 3
  • Carlo Buonomo
    • 3
  • Heung Bae Kim
    • 2
  • Tom Jaksic
    • 1
  1. 1.Department of Surgery, Center of Advanced Intestinal RehabilitationBoston Children’s HospitalBostonUSA
  2. 2.Department of SurgeryBoston Children’s HospitalBostonUSA
  3. 3.Department of RadiologyBoston Children’s HospitalBostonUSA

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