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Ernesto Valdes MD, Guest Editor
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STEP Surgery for Short Bowel
SURGICAL INTERVENTION FOR GASTROINTESTINAL
DISORDERS
Speaker Tom Jaksic, M.D., PhD; Harvard School of Medicine
What struck me the most of Dr. Jaksic’s excellent talk was a particular procedure he is performing for Short Bowel Syndrome. It is called the S.T.E.P. procedure, or Serial Transverse Enteroplasty, and he is performing it at Boston Children’s Hospital. This procedure was successful in lengthening the bowel and restoring bowel function in a pig model of short bowel syndrome.
|
|
Mean ± SD (n=6) |
|
Before STEP |
49.2 ± 2.0 cm* |
|
After STEP |
82.8 ± 6.7 cm* |
|
Immediate Increase |
33.6 ± 6 cm |
|
% Increase |
68 + 11% |
|
*p < 0.01 |
|
Intestinal Diameter
|
|
Mean ± SD (n=6) |
|
Dilated Bowel |
6.2 ± 0.7 cm |
|
Initial STEP Channel |
2.1 ± 0.2 cm* |
|
Final STEP Channel |
4.3 ± 0.7 cm* |
|
Initial Control Bowel |
3.6 ± 0.2 cm |
|
Final Control Bowel |
3.8 ± 0.4 cm |
|
*p < 0.05 |
|
The bowel length would nearly double after the S.T.E.P. procedure. The intestinal diameter would also nearly double.
Absorption of D-Xylose, serum triglycerides, vitamin D and serum albumin would increase. Serum citrulline levels (a biochemical marker of mucosal mass) were nearly doubled. Months after the procedure, Upper Gastrointestinal Series showed normal bowel loop distension. These patients’ bilirubin levels returned to normal and could achieve full enteral nutrition.
Comments. This may not be the total answer for our patients with short gut syndrome. It is another alternative we may offer our patients in addition to the Bianchi Procedure or Intestinal Transplant. EV.
What a clever idea for bowel lengthening. It reminds me of paper doll cut-outs. ABK.
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