Predicting Short Bowel Syndrome Enteral Autonomy: Small Bowel Diameter

In a small retrospective single-center study (GC Ives et al. J Pediatr 2016; 178: 275-7), the authors found that small bowel diameter, as measured on calibrated luminal contrast studies was predictive of enteral autonomy.

Measurements of >35 mm of bowel lumen was considered dilated.  29 patients had adequate imaging for the study.  Necrotizing enterocolitis was the most common etiology of short bowel syndrome in this study.  16 (55%) of the intestinal failure group achieved enteral autonomy in an average of 1.3 years.  11 (38%) of patients underwent an intestinal lengthening procedure.

Key findings:

  • Small bowel diameter correlated negatively with residual small bowel length
  • Larger small bowel diameter predicted failure to achieve enteral autonomy.  In fact, only one patient in this study with a dilated small bowel diameter achieved enteral autonomy.

My take: Bigger (diameter) is not better.

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