Intestinal Continuity Alleviates Pediatric Intestinal Failure-Associated Liver Disease

Jinling Wang; Weihui Yan; Lina Lu; Yijing Tao; Liufang Huang; Wei Cai; Ying Wang

doi:10.3389/fsurg.2022.881782

Intestinal Continuity Alleviates Pediatric Intestinal Failure-Associated Liver Disease

Front Surg. 2022 May 16:9:881782. doi: 10.3389/fsurg.2022.881782. eCollection 2022.

Authors

Jinling Wang¹, Weihui Yan^{1

2}, Lina Lu¹, Yijing Tao¹, Liufang Huang¹, Wei Cai^{1

2

3

4}, Ying Wang^{1

2}

Affiliations

¹ Division of Pediatric Gastroenterology and Nutrition; Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
³ Department of Pediatric Surgery; Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Shanghai Institute for Pediatric Research, Shanghai, China.

Abstract

Background: Type I short bowel syndrome (SBS) occurs after a critical reduction in the functional gut mass and resection of intestinal continuity after ileostomy or jejunostomy for necrotizing enterocolitis (NEC), intestinal atresia or other causes. SBS is often accompanied with intestinal failure-associated liver disease (IFALD) who requires long-term parenteral nutrition (PN). Our study aimed to observe the effect of intestinal continuity on the hepatic function of pediatric intestinal failure (IF) patients with type I SBS.

Methods: The pre-and post-anastomosis medical records of 35 pediatric patients with type I SBS from April 2013 to April 2019 were reviewed retrospectively. The average growth (cm/month) in the proximal and distal small bowel lengths was calculated as the growth in intestinal length (cm)/the duration (month) from enterostomy to anastomosis. The changes in hepatic function from enterostomy to anastomosis were evaluated by assessment of hepatic function before anastomosis for 6 weeks and after anastomosis for 4 weeks.

Results: The average growth in proximal intestinal length was 9.3 cm/month (±7.2) in neonates and 2.8 cm/month (1.3, 11.9) in infants and children, and in distal intestinal length was 1.5 cm/month (0, 2.7) in neonates and 0.4 cm/month (0, 1.4) in infants and children. The incidence of IFALD was 28.6% 1 month before anastomosis and 20.0% 1 month after anastomosis (p < 0.05).

Conclusion: In pediatric type I SBS with IFALD, restoration of intestinal continuity may alleviate liver injury. There was an intestinal compensatory effect on the growth in the intestinal length after resection, and better results were seen in neonates in terms of intestinal length growth.

Keywords: anastomosis; growth in intestinal length; intestinal continuity; intestinal failure associated liver disease; short bowel syndrome.