The evidence on the safety of the serial transverse enteroplasty procedure (STEP) for bowel lengthening in parenteral nutrition-dependent children is adequate; however, there is limited evidence of its efficacy. Therefore, this procedure should not be used without special arrangements for consent and for audit or research.
Clinicians wishing to undertake STEP for bowel lengthening in parenteral nutrition-dependent children should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that parents or carers understand the uncertainty about the procedure's efficacy, in addition to its risks. Provide parents or carers with clear written information. In addition, use of NICE's information for the public recommended.
Patient selection should be carried out in the context of a multidisciplinary team experienced in the management of short bowel syndrome (SBS). These teams should consider case selection carefully so that the procedure is only performed on children who are likely to remain dependent on parenteral nutrition.
Clinicians undertaking STEP for bowel lengthening in parenteral nutrition-dependent children should submit data on all patients to the Boston Children's Hospital's International STEP Data Registry.