The Serial Transverse Enteroplasty (STEP) procedure is a new surgical technique for bowel lengthening developed by pediatric surgeons at Children's Hospital Boston. The STEP procedure is designed for patients with short bowel syndrome who are dependent on intravenous (IV) nutrition because they cannot tolerate full use of their gastrointestinal tract. The goal of the STEP procedure is to increase the length of the small intestine so that patients can better tolerate nutrition through the gastrointestinal tract and eventually wean from IV nutrition.

The STEP procedure relies on the simple anatomic principle that the blood supply to the small bowel travels from the mesentery and traverses the bowel perpendicular to its long axis. In the STEP operation, special devices are used to simultaneously cut and staple the bowel in a direction parallel to this plane. Immediately after the STEP procedure, the small bowel has a "zigzag" appearance from these staples lines.

The STEP procedure was first performed in 2002 at Children's Hospital Boston and is now being performed by pediatric surgeons around the world. The STEP Data Registry was recently started in Spring, 2004, to collect and analyze data from patients who undergo the STEP procedure. After permission is granted from the patient and/or family, surgeons who perform the operation will enter data from their patients directly into the Data Registry for future analysis by investigators at Children's Hospital Boston. The goal of the registry is to assess the long-term outcomes of the STEP procedure and compare it to other bowel lengthening operations. It will likely take several years to obtain enough data for these statistical analyses.

While the STEP operation has shown promising early results in select patients, the operation is not for everyone with short bowel syndrome. To read more about the STEP procedure, please click on "Links" at the top of the page. To contact a pediatric surgeon at Children's Hospital Boston for more information about the STEP procedure, click on "Contact Us" at the top of the page.

For physicians who would like access to and more information about the STEP Data Registry, please register to gain access to the data collection page.

STEP Procedure Illustration