Name of the Procedure:

Fecal Microbiota Transplant (FMT) via Instillation
HCPCS Code: G0455

Summary

Fecal Microbiota Transplant (FMT) is a procedure where stool from a healthy donor is processed and introduced into the gastrointestinal tract of a patient. This method aims to restore the natural balance of bacteria in the patient’s gut.

Purpose

FMT is primarily used to treat recurrent Clostridioides difficile infections (CDI) that have not responded to other treatments. The goal is to repopulate the gut with beneficial bacteria to combat harmful pathogens.

Indications

• Recurrent or refractory Clostridioides difficile infection (CDI)
• Other severe gastrointestinal disorders like Inflammatory Bowel Disease (under experimental consideration)
• Patients with proven dysbiosis not responding to conventional treatments

Preparation

• Patients may need to stop certain medications, such as antibiotics, before the procedure.
• Bowel preparation similar to colonoscopy prep may be required.
• Donor stool is rigorously screened for infectious agents and suitability.

Procedure Description

1. Donor Assessment: Donor samples are carefully screened for pathogens and suitability.
2. Preparation: The stool is processed, filtered, and diluted in saline.
3. Instillation: The prepared fecal microbiota is introduced via colonoscopy, enema, or sometimes through a naso-enteric tube.
4. Assessment: Post-procedure evaluation to ensure the transplant's effectiveness and patient’s well-being.

Duration

The procedure typically takes about 30-60 minutes.

Setting

FMT is usually performed in a hospital, outpatient clinic, or endoscopy center.

Personnel

• Gastroenterologist or specialized medical doctor
• Nursing staff
• Possible involvement of an anesthesiologist if sedation is used

Risks and Complications

• Common risks include abdominal discomfort and bloating.
• Rare risks encompass infections, adverse reactions to donor stool, and transmission of infectious agents.
• Potential complications might be managed with antibiotics or supportive care.

Benefits

• High success rates in treating recurrent CDI.
• Patients often see improvement within days to weeks.

Recovery

• Patients may experience mild gastrointestinal symptoms.
• Advised to avoid antibiotics for a period post-procedure.
• Follow-up appointments to monitor symptoms and ensure complete recovery are important.
• Normal activities can often be resumed shortly after the procedure.

Alternatives

• Long-term antibiotic therapy, which carries the risk of recurrence.
• Probiotics, though they vary in effectiveness.
• More radical surgical interventions in severe cases, like colectomy.

Patient Experience

• The procedure is generally well-tolerated with minimal discomfort.
• Sedation might be used, making the experience similar to a colonoscopy.
• Pain management strategies and supportive care are available to ensure patient comfort.