Report of 111 consecutive patients enrolled in the international serial transverse enteroplasty (STEP) data registry: A retrospective observational study

Brian A. Jones, Melissa A. Hull, Kristina M. Potanos, David Zurakowski, Shimae C. Fitzgibbons, Y. Avery Ching, Christopher Duggan, Tom Jaksic, Heung Bae Kim

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. Study Design: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI, 12-30). Conclusions: Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.

Original languageEnglish (US)
Pages (from-to)438-446
Number of pages9
JournalJournal of the American College of Surgeons
Volume216
Issue number3
DOIs
StatePublished - Mar 1 2013

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Observational Studies
Registries
Small Intestine
Retrospective Studies
Transplantation
Enteral Nutrition
Bilirubin
Short Bowel Syndrome
Parenteral Nutrition
Kaplan-Meier Estimate
Multivariate Analysis
Logistic Models
Regression Analysis
Databases
Mortality

Keywords

  • PN
  • SBS
  • STEP
  • aMSA
  • actual mucosal surface area
  • fMSA
  • functional mucosal surface area
  • parenteral nutrition
  • serial transverse enteroplasty
  • short bowel syndrome

ASJC Scopus subject areas

  • Surgery

Cite this

Report of 111 consecutive patients enrolled in the international serial transverse enteroplasty (STEP) data registry : A retrospective observational study. / Jones, Brian A.; Hull, Melissa A.; Potanos, Kristina M.; Zurakowski, David; Fitzgibbons, Shimae C.; Ching, Y. Avery; Duggan, Christopher; Jaksic, Tom; Kim, Heung Bae.

In: Journal of the American College of Surgeons, Vol. 216, No. 3, 01.03.2013, p. 438-446.

Research output: Contribution to journalArticle

Jones, Brian A. ; Hull, Melissa A. ; Potanos, Kristina M. ; Zurakowski, David ; Fitzgibbons, Shimae C. ; Ching, Y. Avery ; Duggan, Christopher ; Jaksic, Tom ; Kim, Heung Bae. / Report of 111 consecutive patients enrolled in the international serial transverse enteroplasty (STEP) data registry : A retrospective observational study. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 3. pp. 438-446.
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abstract = "Background: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. Study Design: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47{\%}) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95{\%} CI, 12-30). Conclusions: Overall mortality post-STEP was 11{\%}. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47{\%} attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.",
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AU - Jones, Brian A.

AU - Hull, Melissa A.

AU - Potanos, Kristina M.

AU - Zurakowski, David

AU - Fitzgibbons, Shimae C.

AU - Ching, Y. Avery

AU - Duggan, Christopher

AU - Jaksic, Tom

AU - Kim, Heung Bae

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N2 - Background: The International Serial Transverse Enteroplasty (STEP) Data Registry is a voluntary online database created in 2004 to collect information on patients undergoing the STEP procedure. The aim of this study was to identify preoperative factors that are significantly associated with transplantation or death or attainment of enteral autonomy after STEP. Study Design: Data were collected from September 2004 to January 2010. Univariate and multivariate logistic regression analyses were applied to determine the predictors of transplantation or death or enteral autonomy post-STEP. Time to reach full enteral nutrition was estimated using a Kaplan-Meier curve. Results: Fourteen of the 111 patients in the Registry were excluded due to inadequate follow-up. Of the remaining 97 patients, 11 patients died and 5 progressed to intestinal transplantation. On multivariate analysis, higher direct bilirubin and shorter pre-STEP bowel length were independently predictive of progression to transplantation or death (p = 0.05 and p < 0.001, respectively). Of the 78 patients who were 7 days of age or older and required parenteral nutrition at the time of STEP, 37 (47%) achieved enteral autonomy after the first STEP. Longer pre-STEP bowel length was also independently associated with enteral autonomy (p = 0.002). Median time to reach enteral autonomy based on Kaplan-Meier analysis was 21 months (95% CI, 12-30). Conclusions: Overall mortality post-STEP was 11%. Pre-STEP risk factors for progressing to transplantation or death were higher direct bilirubin and shorter bowel length. Among patients who underwent STEP for short bowel syndrome, 47% attained full enteral nutrition post-STEP. Patients with longer pre-STEP bowel length were significantly more likely to achieve enteral autonomy.

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KW - short bowel syndrome

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