Jeremy G Fisher1, Danielle A Stamm1, Biren P Modi1, Christopher Duggan2, Tom Jaksic3. 1. Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School. 2. Division of Gastroenterology and Nutrition, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School. 3. Department of Surgery, Center for Advanced Intestinal Rehabilitation (CAIR), Boston Children's Hospital and Harvard Medical School. Electronic address: tom.jaksic@childrens.harvard.edu.
Abstract
PURPOSE: Serial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure. Evaluation and treatment of serious late gastrointestinal bleeding (GIB) in three STEP patients are described. METHODS: Patients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB requiring transfusion. RESULTS: Of 296 patients, 23 underwent STEP, and 3 (13%) had subsequent GIB requiring transfusion. Diagnoses were vanishing gastroschisis/atresia, malrotation/atresia, and gastroschisis.. STEP was performed at ages 3-5 months, using 5-15 stapler-firings with an increase in mean bowel length from 39 to 62 cm. GIB was diagnosed 5-30 months post-op and resulted in 1-7 transfusions per patient. Endoscopy demonstrated staple-line ulceration in two patients and eosinophilic enterocolitis in the third. All were treated with enteral antibiotics, sulfasalazine, and luminal steroids. Those with ulcers responded to bowel rest, and the patient with eosinophilic enterocolitis stabilized with luminal steroids. In all three, hemoglobin levels improved despite persistent occult bleeding. CONCLUSIONS: Significant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in treating post-STEP GIB, without the need for additional bowel resection.
PURPOSE: Serial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure. Evaluation and treatment of serious late gastrointestinal bleeding (GIB) in three STEP patients are described. METHODS:Patients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB requiring transfusion. RESULTS: Of 296 patients, 23 underwent STEP, and 3 (13%) had subsequent GIB requiring transfusion. Diagnoses were vanishing gastroschisis/atresia, malrotation/atresia, and gastroschisis.. STEP was performed at ages 3-5 months, using 5-15 stapler-firings with an increase in mean bowel length from 39 to 62 cm. GIB was diagnosed 5-30 months post-op and resulted in 1-7 transfusions per patient. Endoscopy demonstrated staple-line ulceration in two patients and eosinophilic enterocolitis in the third. All were treated with enteral antibiotics, sulfasalazine, and luminal steroids. Those with ulcers responded to bowel rest, and the patient with eosinophilic enterocolitis stabilized with luminal steroids. In all three, hemoglobin levels improved despite persistent occult bleeding. CONCLUSIONS: Significant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in treating post-STEP GIB, without the need for additional bowel resection.
Authors: Govardhana Rao Yannam; Debra L Sudan; Wendy Grant; Jean Botha; Alan Langnas; Jon S Thompson Journal: J Gastrointest Surg Date: 2010-08-24 Impact factor: 3.452
Authors: Kuang Horng-Jamie Kang; Ivan M Gutierrez; David Zurakowski; Stephanie Diperna; Carlo Buonomo; Heung Bae Kim; Tom Jaksic Journal: Pediatr Surg Int Date: 2012-11-16 Impact factor: 1.827