Re: Re: Bowel Lengthening Procedures in Children with Short Bowel Syndrome: A Systematic Review.

We thank the author of the letter for raising this valid point with regards to the possibility of multiple counting of patient through inclusion of several studies from the same centers. During the writing of our article we contacted the corresponding authors of the included papers, if contact information was provided, with the question to clarify if patients were included in several studies. We did not receive clarification on these enquiries and therefore included al studies. Per suggestion of the author of the letter we have made a separate analysis excluding all studies from similar centers with complete overlap with regards to the time period studied. Below we present the updated results on the most important outcomes of our systematic review. Of the original 40 studies, 13 were excluded. Eleven studies discussed the effects of first LILT (a total of 213 of the original 324 patients are described). Eleven studies discussed the effects of first STEP (a total of 279 of the original 377 patients are described). With regards to LILT 56% of patients were completely weaned from parenteral nutrition (PN) at end of follow-up, compared to 52% described in our article with all included studies. With regards to STEP 54% of patients were completely weaned from PN at end of follow-up, compared to 45% described in our article with all included studies. With regards to LILT 21% of patients had died at end of follow-up, compared to 26% described in our article with all included studies. With regards to STEP 6% of patients had died at end of follow-up, compared to 7% described in our article with all included studies. These results do not differ greatly to our systematic review. As discussed in our review we could not compare LILT versus STEP due to incomparability between groups as different time periods are described were supportive care for patient suffering from short bowel syndrome evolved greatly. As our updated results after exclusion of double patient inclusion due to inclusion of studies from the same centers do not differ greatly we believe that the conclusion of our article remains valid: "LILT and STEP are both valuable treatment strategies used in the management of pediatric short bowel syndrome. However, currently, it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention." Furthermore this issue further raises the necessity of homogenous, prospective outcome reporting.