Serial Transverse Enteroplasty Procedure (STEP)

Children with short bowel syndrome lack a functioning small intestine as the result of conditions including necrotizing enterocolitis (NEC), intestinal atresia, complicated gastroschisis, and volvulus. An insufficient length of small intestine can make it difficult or impossible for kids with short bowel syndrome to extract the nutrients they need to grow and thrive. For this reason, many children with the condition require parenteral nutrition through an intravenous (IV) line, enteral nutrition through a gastrostomy tube (G-tube), or both.

To lengthen the small intestine of children with short bowel syndrome, physicians at Boston Children's Hospital developed an operation called the serial transverse enteroplasty procedure (STEP). This procedure lengthens the small intestine to create more useable surface area and make a narrower space, which keeps food moving through your child's digestive tract at an appropriate pace to improve function.

STEP relies on the simple anatomic principle that the small bowel's blood supply travels from the mesentery (a fold of membrane that attaches the intestine to the abdominal wall) at right angles to the bowel. During the STEP surgery, your child's surgeon will make a row of alternating slits along the small intestine and staple shut the edges on each side of these V-shaped cuts. Following STEP, the small intestine resembles a long and thinner zigzag-like tube. The goal of STEP is to increase the length of the small intestine so that children can better tolerate nutrition through the gastrointestinal tract and to promote enteral nutrition. STEP allows about 50 percent of children to wean from IV nutrition.

Watch a video of an actual STEP procedure.

Boston Children's surgeons Heung Bae Kim, MD, and Tom Jaksic, MD, developed the STEP as a way to lengthen the small intestines of children with short bowel syndrome. In 2002, they performed the first STEP surgery in the world. Since then, our surgeons have performed many of these procedures with success, establishing the Boston Children's Center for Advanced Intestinal Rehabilitation as one of the world's preeminent destinations for the treatment of short bowel syndrome. Since 2004, the center has used the International STEP Data Registry to track outcomes of children who have had the procedure, so that we can better understand its effectiveness compared to other therapies.