Related Experiment Video
Updated: Jul 12, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Colonic distribution of FMT by different enema procedures compared to colonoscopy - proof of concept study using
Linn Kallbekken Skjevling1,2, Hege Marie Hanssen1,2, Per Christian Valle2,3
1Medical Department, Research Unit, University Hospital of North-Norway Harstad, St. Olavs gt. 70, Harstad, Norway.
Background:
Fecal microbiota transplantation (FMT) has become an important treatment method in recurrent Clostridioides difficile infections and is under investigation as a treatment for several other diseases. FMT's mechanism of action is assumed to be through alterations of the colon microbiota. FMT can be delivered by several methods, but few studies have directly compared how FMT is distributed in the colon by different methods. Specifically, the proximal distribution of FMT delivered by enema is unknown.
Methods:
In eight participants, we administered contrast fluid (CF) with viscosity similar to an FMT in a crossover study design. First, CF was administered by colonoscopy, followed by an abdominal X-ray to visualize the CF distribution. Next, after four to eight weeks, participants were given CF, but as an enema, followed by a positioning procedure. X-rays were obtained before (enema ÷) and after (enema +) the positioning procedure.
Conclusion:
Proportion of participants with CF in cecum were 100% after colonoscopy, 50% after enema + and 38% after enema ÷. In the transverse colon, proportions were 100% (colonoscopy), 88% (enema +) and 63% (enema ÷). There were no adverse events.
Interpretation:
This study shows proof of concept for the distribution of FMT to proximal colon when delivered by enema. A positioning procedure after the enema slightly improves the proximal distribution. However, colonoscopy is the only method that ensures delivery to the cecum. Studies are needed to see if FMT colon distribution correlates with treatment effectiveness.
Trial Registration:
The study was retrospectively registered at ClinicalTrials.gov (NCT05121285) (16/11/2021).
Insights
Fecal microbiota transplantation (FMT) delivered by colonoscopy reaches the entire colon, while enema delivery shows limited proximal distribution. A positioning procedure may slightly improve enema delivery, but colonoscopy remains superior for reaching the cecum.
Area of Science:
- Gastroenterology
- Microbiome Research
- Medical Imaging
Background:
- Fecal microbiota transplantation (FMT) is a key treatment for recurrent Clostridioides difficile infections.
- Its efficacy is linked to altering gut microbiota, but delivery methods and their impact on colon distribution are poorly understood.
- The proximal distribution of FMT via enema remains largely unknown.
Purpose of the Study:
- To compare the proximal distribution of fecal microbiota transplantation (FMT) when delivered via colonoscopy versus enema.
- To evaluate the effect of a post-enema positioning procedure on FMT distribution.
Main Methods:
- A crossover study involving eight participants administered contrast fluid (CF) with FMT-like viscosity.
- CF was delivered via colonoscopy and subsequently via enema, with X-rays used to visualize distribution.
- Enema delivery was assessed with and without a positioning procedure.
Main Results:
- Colonoscopy ensured 100% contrast fluid (CF) delivery to the cecum and transverse colon.
- Enema delivery reached the cecum in 50% of participants with a positioning procedure and 38% without.
- Transverse colon CF distribution was 88% with the positioning procedure and 63% without.
Conclusions:
- Colonoscopy is the most effective method for ensuring FMT reaches the cecum.
- Enema delivery, even with a positioning procedure, has limited proximal colonic distribution.
- Further research is needed to correlate FMT distribution with treatment outcomes.
Related Concept Videos
01:25Endoscopic Procedures II: Colonoscopy
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:23Lower GI Series: Barium Enema
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...