Re: Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review

Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review

Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review

We thank the author of the letter for raising this valid point with regard to the possibility of multiple counting of patient through inclusion of several studies from the same centers. During the writing of our article,[1] we contacted the corresponding authors of the included studies, if their contact information was provided, with the question to clarify if patients were included in several studies. We did not receive clarification on these enquiries and therefore included all the studies.

Per the suggestion of the author of the letter, we have made a separate analysis excluding all studies from similar centers with complete overlap with regard to the time period studied. Below we present the updated results on the most important outcomes of our systematic review.

Of the original 40 studies, 13 were excluded ([Table 1]). Eleven studies discussed the effects of first the longitudinal intestinal lengthening and tailoring (LILT; a total of 213 of the original 324 patients are described). Eleven studies discussed the effects of the first serial transverse enteroplasty (STEP; a total of 279 of the original 377 patients are described).

Table 1 Studies included after removal

LILT
Bianchi 1997	20
Bonnard et al 2005	7
Figueroa-Colon et al 1996	7
Hosie et al 2006	49
Huskisson et al 1993	3
Khalil et al 2012	19
Reinshagen et al 2008	55
Thompson et al 2000	13
Walker et al 2006	19
Weber and Powell 1996	5
Weber 1999	16
STEP
Bueno et al 2015	3
Fitzgerald et al 2019	36
Fujioka and Cowles 2015	18
Javid et al 2013	16
Jones et al 2013	97
Kang et al 2012	16
Leung et al 2012	4
Lourenco et al 2012	3
Mercer et al 2014	51
Wester et al 2014	12
Wester et al 2017	27
LILT versus STEP
Miyasaka et al 2011	14
Shah et al 2019	22
Re-STEP
Andres et al 2008	12
STEP versus re-STEP
Barrett et al 2017	17
Early versus late bowel lengthening procedure
Wood et al 2013	14

Abbreviations: LILT, longitudinal intestinal lengthening and tailoring; re-STEP, repeat STEP; STEP, serial transverse enteroplasty.

With regard to LILT, 56% of patients were completely weaned from parenteral nutrition at the end of follow-up, compared to 52% described in our article with all the included studies.

With regard to STEP, 54% of patients were completely weaned from parenteral nutrition at the end of follow-up, compared to 45% described in our article with all the included studies.

With regard to LILT, 21% of patients had died at the end of follow-up, compared to 26% described in our article with all the included studies.

With regard to STEP, 6% of patients had died at the end of follow-up, compared to 7% described in our article with all the included studies.

These results do not differ greatly from our systematic review. As discussed in our review, we could not compare LILT versus STEP due to incomparability between groups as different time periods are described were supportive care for patient suffering from short bowel syndrome evolved greatly.

As our updated results after exclusion of double patient inclusion due to inclusion of studies from the same centers do not differ greatly, we believe that the conclusion of our article remains valid: “LILT and STEP are both valuable treatment strategies used in the management of pediatric short bowel syndrome. However, currently, it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention.” Furthermore, this issue further raises the necessity of homogenous, worldwide, prospective outcome reporting to improve the quality of research, and thereby the care, for patients with this rare condition.

Publication History

Received: 30 June 2023

Accepted: 10 July 2023

Accepted Manuscript online:
12 July 2023

Article published online:
30 September 2023

• References

• 1 Nagelkerke SCJ, Poelgeest MYV, Wessel LM. et al; ERNICA Intestinal Failure Working Group. Bowel lengthening procedures in children with short bowel syndrome: a systematic review. Eur J Pediatr Surg 2022; 32 (04) 301-309