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Oral Presentation - 147
PROGNOSTIC IMPLICATIONS OF RESIDUAL BOWEL LENGTH IN PEDIATRIC SHORT BOWEL SYNDROME: FOCUS ON THE <25% COHORT
Audelia Eshel-Fuhrer 1, Kira Fridman 1, Igor Sukhotnik 2
1 Tel Aviv Sourasky Medical Center’s Dana-Dwek Children’s Hospital, Tel Aviv, Israel, Department of Pediatric surgery
2 Tel Aviv Sourasky Medical Center’s Dana-Dwek Children’s Hospital, Tel Aviv, Israel, Department of Pediatric surgery; Sackler Faculty of Medicne, Tel Aviv University, Tel Aviv, Israel
Purpose: The definition of short-bowel-syndrome (SBS) considers two factors; either a residual small bowel (SB) length <25% or a prolonged need for parenteral nutrition (PN). Although all SBS children have prolonged PN dependence, just a portion of them also have <25% remaining SB. To date, children with SBS are considered a single patients group. We aimed to distinguish SBS children with <25% remaining SB from other SBS children.
Methods: An Intestinal Rehabilitation Center’s retrospective cohort (2003-2023) of 47 children, who were divided into two groups according to SB measurements; Group A <25% and group B≥25%. PN duration, enteral autonomy (EA) rates, catheter related complications, hepatic complications, and additional abdominal surgeries were compared.
Results: Sixteen children were included in group A and 31 in group B. Children from group A were less likely to have a remaining ileocecal valve (A-31% vs B-61%, p=0.05), and to reach EA (37.5% vs 77.5%, p=0.007). Catheter-related bacteremia and cholestasis were more prevalent in group A (68.8% and 31.3%) compared to group B (48.4% and 21.6%), respectively (p>0.05). Upon follow up, more children from group A required a gastrostomy (83.9% vs 16.1%, p=0.001) and a lengthening STEP procedure (50% vs 15.4%, p=0.019).
Conclusion: our experience shows that SBS children with <25% residual SB represent a distinct high-risk subgroup with a more complicated course and inferior outcomes. These findings might justify a separate recognition in research and clinical decision-making. This study underscores the need for personalized management in SBS. However, to gain more insights about this subgroup further prospective studies are needed.