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Serial transverse enteroplasty (STEP) in case of short bowel syndrome: did we achieve our goal? A systematic review

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Abstract

Surveys on Serial Transverse Enteroplasty (STEP) published in international literature (1 January 2003– 31 May 2021) were searched. Articles were included from 17 countries: 1/23 comparative and 22/23 cohort studies. STEP was performed on 308 patients: pediatrics, adults, and mixed ages. Pediatric group included 16 studies and the adult 6. Pre-STEP residual small bowell (SB) length for pediatrics and adults ranged from 18 to 26 cm and from 30 to 70 cm, respectively. Post-STEP increased SB length for pediatrics and adults ranged between 42 and 100% and 50% and 176%, respectively. For pediatrics, enteral autonomy was reached in 32.22% of cases, parenteral nutrition (PN) dependence was 36.11%, a repeated STEP procedure (Re-STEP) was needed in 17.22%, and a bowel transplant was performed in 6.11%. In adults, enteral autonomy was achieved in 52.38%, while PN dependence was 37.1%, and no Re-STEP or transplantation were required. For the mixed group, post-STEP bowel length increased from 2 to 50 cm, enteral autonomy was obtained in 43%, PN dependence was 57%, without reported Re-STEP or transplantation. Mortality rates were between 5.55% (pediatric) and 7.14% (adults). Preoperative length with preservation of ileocecal valve represented the main predictive factors to achieve enteral autonomy.

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Abbreviations

STEP:

Serial transverse enteroplasty

SBS:

Short bowel syndrome

IF:

Intestinal failure

NR:

Not reported

SB:

Small bowel

TPN:

Total parenteral nutrition

PN:

Parenteral nutrition

Re-STEP:

Repeated STEP

AGIR:

Autologous gastrointestinal reconstruction

LILT:

Longitudinal intestinal lengthening and tailoring

SILT:

Spiral intestinal lengthening and tailoring

IRPs:

Intestinal rehabilitation programs

NEC:

Necrotizing enterocolitis

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Author information

Authors and Affiliations

  1. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy

    A. Lauro, A. Santoro & V. D’Andrea

  2. Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy

    R. Cirocchi & M. Michelini

  3. Ospedale Civile “A. Costa”, Porretta Terme, Bologna, Italy

    N. Zorzetti

  4. Department of Paediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy

    M. C. Cianci, R. Coletta & A. Morabito

  5. Azienda Ospedaliera “San Camillo-Forlanini”, Rome, Italy

    M. I. Bellini

  6. IRCCS Azienda Ospedaliero, Universitaria Di Bologna, Bologna, Italy

    C. Casadei

  7. Ospedale “Ceccarini”, Riccione, Rimini, Italy

    M. C. Ripoli

  8. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    S. Khouzam & I. R. Marino

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  1. A. Lauro
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Correspondence to A. Lauro.

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Lauro, A., Santoro, A., Cirocchi, R. et al. Serial transverse enteroplasty (STEP) in case of short bowel syndrome: did we achieve our goal? A systematic review. Updates Surg 74, 1209–1223 (2022). https://doi.org/10.1007/s13304-022-01316-3

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