Short bowel mucosal morphology, proliferation and inflammation at first and repeat STEP procedures

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Mutanen , A , Barrett , M , Feng , Y , Lohi , J , Rabah , R , Teitelbaum , D H & Pakarinen , M P 2019 , ' Short bowel mucosal morphology, proliferation and inflammation at first and repeat STEP procedures ' , Journal of Pediatric Surgery , vol. 54 , no. 3 , pp. 511-516 .

Title: Short bowel mucosal morphology, proliferation and inflammation at first and repeat STEP procedures
Author: Mutanen, Annika; Barrett, Meredith; Feng, Yongjia; Lohi, Jouko; Rabah, Raja; Teitelbaum, Daniel H.; Pakarinen, Mikko P.
Contributor organization: Children's Hospital
University of Helsinki
Department of Pathology
Lastenkirurgian yksikkö
HUS Children and Adolescents
Date: 2019-03
Language: eng
Number of pages: 6
Belongs to series: Journal of Pediatric Surgery
ISSN: 0022-3468
Abstract: Background: Although serial transverse enteroplasty (STEP) improves function of dilated short bowel, a significant proportion of patients require repeat surgery. To address underlying reasons for unsuccessful STEP, we compared small intestinal mucosal characteristics between initial and repeat STEP procedures in children with short bowel syndrome (SBS). Methods: Fifteen SBS children, who underwent 13 first and 7 repeat STEP procedures with full thickness small bowel samples at median age 1.5 years (IQR 0.7-3.7) were included. The specimens were analyzed histologically for mucosal morphology, inflammation and muscular thickness. Mucosal proliferation and apoptosis was analyzed with MIB1 and Tunel immunohistochemistry. Results: Median small bowel length increased 42% by initial STEP and 13% by repeat STEP (p - 0.05), while enteral caloric intake increased from 6% to 36% (p 0.07) during 14 (12-42) months between the procedures. Abnormal mucosal inflammation was frequently observed both at initial (69%) and additional STEP (86%, p 0.52) surgery. Villus height, crypt depth, enterocyte proliferation and apoptosis as well as muscular thickness were comparable at first and repeat STEP (p>0.05 for all). Patients, who required repeat STEP tended to be younger (p 0.057) with less apoptotic crypt cells (p-0.031) at first STEP. Absence of ileocecal valve associated with increased intraepithelial leukocyte count and reduced crypt cell proliferation index (p Conclusions: No adaptive mucosal hyperplasia or muscular alterations occurred between first and repeat STEP. Persistent inflammation and lacking mucosal growth may contribute to continuing bowel dysfunction in SBS children, who require repeat STEP procedure, especially after removal of the ileocecal valve. (C) 2018 Elsevier Inc. All rights reserved.
Subject: Apoptosis
Intestinal failure
Parenteral nutrition
Small bowel
3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion

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