J Pediatr Gastroenterol Nutr. 2024 Oct;79(4):915-923. doi: 10.1002/jpn3.12316.Epub 2024 Jul 20.

Jonathan A Salazar ^1 2, Christina Chan ³, Enju Liu ³, Fatima Hamroud ⁴, Amit S Grover ¹, Victor L Fox ¹, Peter D Ngo ¹, Lissette Jimenez ^1 2, Christopher P Duggan ^1 2, Alexandra N Carey ^1 2

Author information

¹Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.

²Center for Advanced Intestinal Rehabilitation and Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.

³Institutional Centers for Clinical and Translational Research (ICCTR), Boston Children's Hospital, Boston, Massachusetts, USA.

⁴Gastroenterology Procedure Unit, Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

Objectives: In pediatric patients with intestinal failure (IF) due to short bowel syndrome (SBS), we hypothesized that young children, those with shorter residual small bowel and those with congenital malrotation of the bowel would be more likely to undergo pan-enteroscopy. We aimed to determine the feasibility and diagnostic yield of pan-enteroscopy in this cohort.

Methods: We performed a single-center, retrospective study of pediatric patients with IF due to SBS who had undergone at least one GI endoscopic evaluation between January 1, 2018 and January 1, 2023.

Results: A pan-enteroscopy might have been possible in 381 of the 431 procedures (206 patients) reviewed. Forty-four (21%) patients underwent 54 pan-enteroscopies. Children with a residual bowel length <35 cm had higher odds of undergoing pan-enteroscopy (odds ratio [OR] 3.72, 95% confidence interval [CI] [1.32, 10.48], p = 0.01), as did patients with periprocedural glucagon-like peptide 2 (GLP-2) analog use (OR 4.30, 95% CI [1.24, 14.95], p = 0.02). Patients with diagnoses other than necrotizing enterocolitis (NEC) tended to be more likely to achieve a pan-enteroscopy (OR 2.73, 95% CI [0.95,7.88], p = 0.06). Evidence of gross and histopathologic abnormalities were found in 77.8% and 78% of the procedures, respectively. No complications were identified.

Conclusion: In a large cohort of children with SBS, pan-enteroscopy was successfully performed in 14.2% of the procedures and microscopic abnormalities were common. Shorter residual bowel length, underlying diagnoses of non-NEC, and GLP-2 analog use were generally associated with successful pan-enteroscopy, independent of age and several other factors. These data suggest that pan-enteroscopy is feasible and of high-yield in a subset of patients with SBS.