Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

Summary

Fecal Microbiota Transplantation via colonoscopy is a safe and effective treatment for recurrent and refractory C.difficile infection. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool during the colonoscopy will maximize therapeutic success.

Abstract

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods of FMT administration have been reported in the literature including nasogastric tube, upper endoscopy, enema and colonoscopy. FMT via colonoscopy yields excellent cure rates and is also well tolerated. We have found that patients find this an acceptable and tolerable mode of delivery. At our Center, we have initiated a fecal transplant program for patients with recurrent or refractory CDI. We have developed a protocol using an iterative process of revision and have performed 24 fecal transplants on 22 patients with success rates comparable to the current published literature. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool maximizes therapeutic success. Here we detail each step of the FMT protocol that can be carried out at any endoscopy center with a high degree of safety and success.

Introduction

Fecal transplants for the treatment of pseumembranous colitis were first described in 1958¹ . However, reports of ingesting feces for the treatment of food poisoning and severe diarrhea date back as early as fourth century China² . Fecal microbiota transplantation (FMT) is also termed in the literature “fecal bacteriotherapy”, “human probiotic infusion”, “stool transplant”, “intestinal microbiome restoration”, and “fecal transfer”. It involves collecting stool from a healthy, pre-screened donor and delivering a prepared slurry into the gastrointestinal tract of the recipient via nasogast....

Protocol

NOTE: At the time of this manuscript publication an Investigational New Drug (IND) application is not required to perform an FMT for recurrent CDI in clinical practice. However, if FMTs are being performed as part of a study or for another indication, an IND or equivalent application may be required¹⁸ . Regulatory agencies will likely continue to assess the safety and efficacy of FMT as applied to CDI and other medical conditions and so it is advised to check the regulatory requirements in your respective location prior to the initiation of an FMT program and every one to two months once actively performing FMT.

NOTE Candidates m....

Results

We have performed 24 FMTs on 22 patients at our Center (Table 1) using the above protocol. Nine patients had concurrent IBD (six with Crohn’s disease and three with ulcerative colitis). All nine had resolution of CDI. One of the patients with Crohn’s disease was status post a total colectomy for Crohn’s colitis. He initially underwent FMT via colonoscopy however after experiencing a recurrence two weeks post FMT he underwent a second FMT via upper endoscopy which resulted in CDI resolution. Eleven out of.......

Discussion

Fecal transplants have been shown to be an effective and safe treatment for recurrent CDI. We have outlined a standard protocol for FMT via colonoscopy and included our results for 22 patients who underwent the procedure for recurrent CDI. Our results thus far are comparable to published data for recurrent disease with only one patient recurring one month post FMT. A critical step of the procedure is the prescreening visit to ensure that the donor is suitable and that the patient has no contraindications to unde.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Blender	Hamilton Beach	51101	Link to Amazon.com
Strainer	Winco	MS3A-8S	Link to Amazon.com
Disposable pads (chux), 17 x 24 in.	hospital standard		one package
Pink rectangular hospital standard wash basin, 8 quart	hospital standard		1 or 2
500 cc bottle of sterile normal saline	hospital standard		2
60 cc luer lock syringes	hospital standard		8 or 9
Biopsy channel cap with extension	hospital standard