Preparation of fecal microbiota for instillation, including assessment of donor specimen
CPT4 code
Name of the Procedure:
Preparation of Fecal Microbiota for Instillation (Fecal Microbiota Transplantation, FMT)
Summary
Fecal Microbiota Transplantation (FMT) involves transplanting stool from a healthy donor into the gastrointestinal tract of a recipient. This procedure aims to restore healthy bacteria balance in the recipient's gut.
Purpose
FMT is primarily used to treat recurrent Clostridioides difficile infections, which cause severe diarrhea and are resistant to standard antibiotics. The goal is to reestablish a healthy gut microbiome and alleviate symptoms.
Indications
- Recurrent or refractory Clostridioides difficile infection: Typically, after multiple failed antibiotic treatments.
- Other potential indications under clinical research include inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome.
Preparation
- Patient: May be required to fast for a few hours before the procedure. Specific instructions regarding current medications like antibiotics are provided.
- Donor: Thorough screening including history, physical examination, and testing for infectious diseases.
- Tests: Stool tests for pathogens, blood tests for transmissible diseases.
Procedure Description
- Donor Screening: Comprehensive assessment for fitness to donate.
- Collection: Donor stool is collected in a sterilized container.
- Processing: The stool sample is mixed with a saline or other suitable solution and then filtered to remove solids.
- Preparation for Instillation: The processed sample is loaded into syringes for administration.
- Instillation Methods: Delivered via colonoscopy, endoscopy, enema, or nasoenteric tube.
- Tools: Sterile containers, syringes, mixing solution, filters.
- Anesthesia: Minimal sedation may be used depending on the administration method.
Duration
The preparation and instillation process typically takes about 2-3 hours, including donor screening.
Setting
The procedure is usually performed in a hospital, outpatient clinic, or gastroenterology clinic equipped for endoscopic procedures.
Personnel
- Gastroenterologists
- Nurses
- Laboratory technicians for processing the sample
- Anesthesiologist if sedation is used
Risks and Complications
- Common: Mild abdominal discomfort, bloating, and gas.
- Rare: Allergic reactions, infections, and the potential transfer of undetected pathogens.
- Management: Regular monitoring and appropriate interventions for any complications.
Benefits
- Rapid resolution of symptoms in most cases.
- Usually dramatic improvement in gut health within days to weeks.
Recovery
- Most patients can resume normal activities within a day.
- Follow specific dietary and activity recommendations.
- Schedule follow-up appointments to monitor progress.
Alternatives
- Prolonged or repeated antibiotic therapy.
- Probiotics, though less effective in some refractory cases.
- Each alternative has varying success rates and potential side effects.
Patient Experience
- During the preparation: Minimal discomfort.
- During the instillation: Mild cramping or bloating.
- Post-procedure: Temporary changes in bowel habits, with pain management usually not necessary. Comfort measures include rest and hydration.