Characteristics and clinical outcomes of pediatric patients following massive bowel resection: A retrospective cohort study

TL;DR

This study examines the outcomes of children who underwent massive bowel resection and identifies factors linked to better recovery and reduced reliance on intravenous nutrition.

Contribution

The study provides updated insights into clinical outcomes and factors associated with enteral autonomy in pediatric patients after massive bowel resection.

Findings

34.4% of patients achieved enteral autonomy, with greater residual bowel and colon length associated with success.

Patients with enteral autonomy were more likely to have an ICV and less likely to undergo a STEP procedure.

Overall transplant and mortality rates were 9.8% and 11.5%, respectively, with improved outcomes compared to prior reports.

Abstract

Massive bowel resection (MBR), defined as residual small bowel < 25 % of expected length-for-age based on established norms, is a rare entity. Traditionally, children who have undergone MBR have higher mortality and less probability of achieving enteral autonomy compared to patients with less substantial bowel loss. The primary objective of this study was to determine the characteristics and clinical outcomes of pediatric patients following MBR. Secondary objectives included comparing patients who achieved enteral autonomy to those who remained parenteral nutrition (PN)-dependent to determine characteristics associated with PN independence.

Retrospective cohort study of patients following MBR managed by our multidisciplinary intestinal rehabilitation program between January 1, 2006 and December 31, 2017, with an observation period ending December 31, 2021.

61 patients with MBR fulfilled study inclusion criteria. 21 patients (34.4 %) achieved enteral autonomy while 40 patients (65.6 %) did not. Patients who achieved enteral autonomy had a greater percentage of residual small bowel (22 % vs 13 %, P < 0.01) and colon (100 % vs 50 %, P < 0.01). They were more likely to have an ICV (73.2 % vs 15 %, P < 0.01) and less likely to undergo STEP procedure (14.3 % vs 37.5 %, P = 0.02). 18 patients in the cohort without enteral autonomy achieved greater than 50 % enteral nutrition. In this cohort, the overall transplant rate was 9.8 % and mortality rate was 11.5 %.

Several important advancements have occurred over the last two decades that have allowed more patients to reach their adaptive potential and mitigate complications of prolonged PN following MBR. Overall outcomes are better than previously reported.