Serial Transverse Duodenal Enteroplasty in Adults With Ultra-Short Bowel Syndrome: A Case Series.

Intestinal failure is defined as a reduction in function below the minimum required for adequate absorption of water, electrolytes, and nutrients, necessitating intravenous support. One of the most common etiologies is short bowel syndrome (SBS). For many years, intestinal transplantation was the only surgical option to achieve reduced dependence on parenteral nutrition (PN). However, intestinal lengthening surgery, such as serial transverse enteroplasty (STEP), has proven to be a safe and effective option for select patients with SBS, including those with ultra-short bowel syndrome (USBS) or PN-dependent SBS. Nevertheless, reported cases of STEP in adults are isolated due to the high complexity of the procedure.  We present a case series of three patients with USBS and type III intestinal failure, in whom STEP was performed as part of intestinal rehabilitation. At the time of writing, one patient achieved enteral autonomy, while the other two have significantly reduced their PN requirements (by 33% and 20%, respectively) and improved oral tolerance. Autologous gastrointestinal reconstruction plays a key role in the treatment of intestinal failure secondary to SBS. Among the surgical options, STEP has been successfully used in children, though adult reports remain scarce, particularly for duodenal lengthening (with ≤ two cases reported globally). Postoperative outcomes are favorable, with low morbidity and mortality, offering the possibility of reducing PN dependence and, in select cases, avoiding intestinal transplantation. STEP is a complex but safe and effective procedure for adult patients with SBS, including USBS. It may enable reduced PN dependence, though further studies are needed to define its role in avoiding transplantation.