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Endoscopic peroral jejunal fecal microbiota transplantation.

Digestive and Liver Disease

Abstract

Background

Fecal microbiota transplantation (FMT) is a valuable treatment modality for recurrent Clostridium difficile (C.difficile) colitis. Multiple questions including the best delivery route and volume remain unanswered. Here, were report a case series of high-volume FMT using endoscopic jejunal application route.

Methods

In prospective observational study, FMT was performed using fresh specimen from healthy unrelated donors to the patients with recurrent or refractory C.difficile colitis. Selection of the route was based on the patient's preferences. Specimens of at least 50 g were dissolved in 500 ml of electrolyte solution and administered using endoscope directly in jejunum.

Results

All procedures led to cure of C.difficile colitis. With exception of one case the procedure was well tolerated. In two cases, we observed FMT-reflux into the stomach despite deep jejunal application and in single case the FMT-reflux led to tracheal aspiration and severe pneumonia.

Conclusions

High-volume FMT via endoscopic jejunal route is an effective treatment option that is well tolerated and easy to perform. Nevertheless, aspiration is potential life threating event that needs to be kept in mind during the FMT-procedure.

Abbreviations: FMT - Fecal microbiota transplantation, C.difficile - Clostridium difficile, BMI - body mass index.

Keywords: fecal microbiota transplantation, aspiration, application, endoscopy..

Footnotes

Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany

Corresponding author. Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital Magdeburg, Leipziger Str. 44, D-39120 Magdeburg. Tel.: +49 391 6713106; fax: +49 391 6713105.