Name: fecal microbiota transplantation via colonoscopy for recurrent c. difficile infection
Uploaded: 2014-12-08T15:00:00
Description: Watch this Scientific Journal Video about Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection at JoVE.com

The authors would like to acknowledge the Infectious Disease Department at Brigham and Women&#8217;s Hospital especially Michael S. Calderwood, MD, MPH for helping us construct this protocol. We would also like to thank the Institution&#8217;s endoscopy center and it&#8217;s leadership team for their support.

注：在此稿件发布时的研究性新药（IND）申请不需要执行FMT在临床实践中经常CDI。但是，如果FMTS正在执行作为研究的一部分，或另一个迹象，一个IND或等效的应用程序可能需要18。监管机构可能会继续评估FMT的安全性和有效性，适用于CDI和其他医疗条件等，建议检查在各自的位置上监管要求的FMT程序的启动和每一至两个月一次前积极履行FMT。 注：考生必须愿意同意粪...

<ol>
	<li>Eiseman, B., Silen, W., Bascom, G. S., Kauvar, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+enema+as+an+adjunct+in+the+treatment+of+pseudomembranous+enterocolitis.">Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis.</a> Surgery. 44 (5), 854-859 (1958).</li><li>Zhang, F., Luo, W., Shi, Y., Fan, Z., Ji, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Should+we+standardize+the+1,700-year-old+fecal+microbiota+transplantation.">Should we standardize the 1,700-year-old fecal microbiota transplantation.</a> Am J Gastroenterol. 107 (11), 1755-1710 (2012).</li><li>Borody, T. J., Paramsothy, S., Agrawal, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+microbiota+transplantation:+indications,+methods,+evidence,+and+future+directions.">Fecal microbiota transplantation: indications, methods, evidence, and future directions.</a> Curr Gastroenterol Rep. 15 (8), 337 (2013).</li><li>Mattila, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+transplantation,+through+colonoscopy,+is+effective+therapy+for+recurrent+Clostridium+difficile+infection.">Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection.</a> Gastroenterology. 142 (3), 490-496 (2012).</li><li>Brandt, L. J., Aroniadis, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+overview+of+fecal+microbiota+transplantation:+techniques,+indications,+and+outcomes.">An overview of fecal microbiota transplantation: techniques, indications, and outcomes.</a> Gastrointest Endosc. 78 (2), 240-249 (2013).</li><li>Aas, J., Gessert, C. E., Bakken, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recurrent+Clostridium+difficile+colitis:+case+series+involving+18+patients+treated+with+donor+stool+administered+via+a+nasogastric+tube.">Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube.</a> Clin Infect Dis. 36 (5), 580-585 (2003).</li><li>Garborg, K., Waagsbo, B., Stallemo, A., Matre, J., Sundoy, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+of+faecal+donor+instillation+therapy+for+recurrent+Clostridium+difficile-associated+diarrhoea.">Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea.</a> Scand J Infect Dis. 42 (11-12), 857-861 (2010).</li><li>Kassam, Z., Lee, C. H., Yuan, Y., Hunt, R. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+microbiota+transplantation+for+Clostridium+difficile+infection:+systematic+review+and+meta-analysis.">Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis.</a> Am J Gastroenterol. 108 (4), 500-508 (2013).</li><li>Kelly, C. R., de Leon, L., Jasutkar, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+microbiota+transplantation+for+relapsing+Clostridium+difficile+infection+in+26+patients:+methodology+and+results.">Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results.</a> J Clin Gastroenterol. 46 (2), 145-149 (2012).</li><li>Lund-Tonnesen, S., Berstad, A., Schreiner, A., Midtvedt, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clostridium+difficile-associated+diarrhea+treated+with+homologous+feces.">Clostridium difficile-associated diarrhea treated with homologous feces.</a> Tidsskr Nor Laegeforen. 118 (7), 1027-1030 (1998).</li><li>MacConnachie, A. A., Fox, R., Kennedy, D. R., Seaton, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Faecal+transplant+for+recurrent+Clostridium+difficile-associated+diarrhoea:+a+UK+case+series.">Faecal transplant for recurrent Clostridium difficile-associated diarrhoea: a UK case series.</a> QJM. 102 (11), 781-784 (2009).</li><li>Mellow, M. H., Kanatzar, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Colonoscopic+fecal+bacteriotherapy+in+the+treatment+of+recurrent+Clostridium+difficile+infection--results+and+follow-up.">Colonoscopic fecal bacteriotherapy in the treatment of recurrent Clostridium difficile infection--results and follow-up.</a> J Okla State Med Assoc. 104 (3), 89-91 (2011).</li><li>Polak, P., Freibergerova, M., Jurankova, J., Kocourkova, H., Mikesova, L., Svacina, R., Husa, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=First+experiences+with+faecal+bacteriotherapy+in+the+treatment+of+relapsing+pseudomembranous+colitis+due+to+Clostridium+difficile.">First experiences with faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to Clostridium difficile.</a> Klin Mikrobiol Infekc Lek. 17 (6), 214-217 (2011).</li><li>Rohlke, F., Surawicz, C. M., Stollman, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fecal+flora+reconstitution+for+recurrent+Clostridium+difficile+infection:+results+and+methodology.">Fecal flora reconstitution for recurrent Clostridium difficile infection: results and methodology.</a> J Clin Gastroenterol. 44 (8), 567-570 (2010).</li><li>Sekirov, I., Russell, S. L., Antunes, L. C., Finlay, B. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gut+microbiota+in+health+and+disease.">Gut microbiota in health and disease.</a> Physiol Rev. 90 (3), 859-904 (2010).</li><li>Yoon, S. S., Brandt, L. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+refractory/recurrent+C.+difficile-associated+disease+by+donated+stool+transplanted+via+colonoscopy:+a+case+series+of+12+patients.">Treatment of refractory/recurrent C. difficile-associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients.</a> J Clin Gastroenterol. 44 (8), 562-566 (2010).</li><li>Brandt, L. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+follow-up+of+colonoscopic+fecal+microbiota+transplant+for+recurrent+Clostridium+difficile+infection.">Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection.</a> Am J Gastroenterol. 107 (7), 1079-1087 (2012).</li><li>Kelly, C. R., Kunde, S. S., Khoruts, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidance+on+preparing+an+investigational+new+drug+application+for+fecal+microbiota+transplantation+studies.">Guidance on preparing an investigational new drug application for fecal microbiota transplantation studies.</a> Clin Gastroenterol Hepatol. 12 (2), 283-288 (2014).</li></ol>

粪便移植已被证明是一种安全有效的治疗复发性CDI。我们提出的标准协议，通过 FMT结肠镜检查，其中包括我们的研究结果为22例患者谁接受的程序反复CDI。我们的研究结果迄今媲美的病情反复发作公布的数据显示，只有一名患者复发后一个月FMT。该过程的一个重要步骤是将预筛选访问，以确保供体是合适的，并且该患者不具有禁忌接受结肠镜检查。筛查一般需要三到四天才能完成的过程可?...

粪便移植的pseumembranous结肠炎的治疗于1958年首次描述了1，但摄入粪便食物中毒和严重腹泻日期的治疗回来，早在四世纪中国2的报道。粪便菌群移植（FMT）也被称为在文献“粪bacteriotherapy”，“人类的益生菌输液”，“粪便移植”，“肠菌群恢复”和“粪便转移”。它包括来自健康，预筛选供体采集粪 ​​便和经由鼻胃管，esophagogastricduodenoscopy，结肠镜检查，或灌肠剂3递送准备好的浆体到受体的胃肠道。很多情况下，系列报道，通过NGT和灌肠给药的药效，但是最近的研究表明，捐助粪便的管理，通过结肠镜检查是安全，高效4。而其它的方法，如鼻胃管给药已经报道，通过结肠镜检查输送给体大便具有较少即时副作用（ 例如腹胀和恶心）4和我们已发现，患者更接受FMT的概念时，它是通过执行结肠镜检查。一个FMT 通过结肠镜检查的治疗优点是在结肠生物量的减少是由于被该过程4之前进行肠灌洗。 多项研究已经调查了FMT的作用，用于治疗结肠炎和腹泻导致的机会性病原体C.难辨 （CDI）。 CDI的发病率继续上升，并且是发病和死亡的一个主要原因与在世界各地的大的经济负担。一线治疗CDI包括抗生素治疗，但复发率已经报道的15-35％5。一些病例和报告都做cumented FMT的CDI难治抗生素4,6-16标准的医疗治疗的安全性和有效性。一项研究观察长期随访的患者FMT后经肠镜检查的CDI报告了91％，主要的治愈率在77例17。 在我们中心（布里格姆与消化内科，肝病及妇女医院内镜科），我们发起的患者复发或难治性CDI粪便移植方案。合适的候选人被定义为谁有反复CDI（3个或更多的情节，或2次发作史是需要住院），或难治性疾病，没有响应传统抗生素的病人患者。我们相信，一个系统的方法来此过程的所有阶段最大限度地提高疗效。在这个手稿和影随行，我们详细介绍我们使用了我们的中心，其中包括患者和供者的筛选，大便准备了协议，和大便交付吨结肠镜检查的时间。这种方法已经产生了相媲美的已发表的文献阳性结果。 病例报告： 这名患者代表提到了粪便移植一个典型的病人。 该患者是一名69岁的女子与慢性淋巴细胞白血病病史谁曾病需要化疗进一步治疗的复发。她患有CDI的三集，在过去的一年中，并因此被称为我们的诊所审议FMT之前重新开始化疗。发生CDI她的第一集于2012年10月，她没有上过前面的抗生素。她病得很重，在ICU脓毒性休克提出后进行分流循环回肠造口顺行灌肠万古霉素为6周的课程，结合给她病情的严重程度万古霉素口服。她的表现非常好，她腹泻分辨率和她能来关闭抗生素。她开发了她周围的造口疝因此它被推翻。不久后造瘘逆转，她再次出现腹泻，被发现再次是C.艰难梭菌毒素阳性。她完成了万古霉素口服另外6周的课程，并能够它逐渐停止成功。然而几个月后，她又开始腹泻，这是C.艰难梭菌毒素阳性，并开始在她的第三万古霉素口服疗程。她对抗生素表现不错时，有人指出，她的白细胞计数增加到&gt; 100，她发现有复发她的骨髓活检CLL的。她的肿瘤学家担心化疗开始没有她CDI完全解决，所以我们被要求进行格式化。

<table border="0" cellpadding="0" cellspacing="0" width="840">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:247px;">Name of Material/ Equipment</td>
			<td style="width:121px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:355px;">Comments/Description</td>
		</tr>
		<tr height="92">
			<td height="92" style="height:92px;width:247px;">Blender</td>
			<td style="width:121px;">Hamilton Beach</td>
			<td style="width:119px;"></td>
			<td style="width:355px;">http://www.amazon.com/Hamilton-Beach-51101-Personal-Blender/dp/B00065L6CU/ref=pd_sim_k_2?ie=UTF8&#38;refRID=1Q06MXAE9XKTB4QG0AEN</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:247px;">Strainer</td>
			<td style="width:121px;">Winco MS3A-8S Strainer</td>
			<td style="width:119px;"></td>
			<td style="width:355px;">http://www.amazon.com/Winco-MS3A-8S-Strainer-Single-Wooden/dp/B001VZ5E40/ref=sr_1_3?s=home-garden&#38;ie=UTF8&#38;qid=1395001295&#38;sr=1-3&#38;keywords=kitchen+strainer+wooden+handle</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:247px;">Disposable pads (chux), 17in x 24in.&#160;</td>
			<td>hospital standard</td>
			<td style="width:119px;"></td>
			<td>one package&#160;</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:247px;">Pink rectangular hospital standard wash basin, 8 quart&#160;</td>
			<td>hospital standard</td>
			<td style="width:119px;"></td>
			<td>1 or 2</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;">500 cc bottle of sterile normal saline</td>
			<td style="width:121px;">hospital standard</td>
			<td style="width:119px;"></td>
			<td>2</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;">60cc leur lock syringes</td>
			<td style="width:121px;">hospital standard</td>
			<td style="width:119px;"></td>
			<td>8 or 9</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;">Biopsy channel cap with extension</td>
			<td style="width:121px;">hospital standard</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

fecal microbiota transplantation via colonoscopy for recurrent c. difficile infection

粪便菌群移植（FMT）是一种安全，高效的治疗复发和难治C.难辨感染（CDI）。 FMT管理的各种方法已经有文献报道，包括鼻胃管，上消化道内镜检查，灌肠和结肠镜检查。 通过肠镜产量出色的治愈率FMT，也很好的耐受性。我们已发现，患者发现这是一个可以接受的和可耐受的递送模式。在我们中心，我们已经开始为患者复发或难治性CDI粪便移植方案。我们已经制定了使用协议修订的迭代过程，并在22例成功率堪比目前公开发表的文献进行24粪便移植。系统的方法对病人和捐赠者的筛选，准备大便，和交付的凳子最大限度地提高治疗成功。下面我们详细的FMT协议，可以进行任何胃镜的每一步中心与安全和成功的程度高。

我们已经完成对22例24 FMTS在我们使用上述协议中心（ 表1）。 9例患者并发IBD（6克罗恩病和三个溃疡性结肠炎）。所有9例CDI的分辨率。其中一名患者与克罗恩病是状态发布全结肠切除克罗恩结肠炎。他最初不过在经历了复发后两周FMT他通过导致CDI分辨率上消化道内镜检查进行了第二次FMT通过结肠镜检查进行格式化。十一出的非IBD患者的13具有相关的为C.症状完全分辨率艰难</e...

Watch this Scientific Journal Video about Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection at JoVE.com

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

通过结肠镜检查粪便菌群移植治疗复发性<em&gt;温度。难辨</em&gt;感染

通过结肠镜检查粪便菌群移植是一种安全，有效的治疗复发和难治艰难梭菌感染。结肠镜检查过程中的系统方法对病人和捐赠者的筛选，准备大便，和交付的凳子将最大限度地提高治疗成功。

Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods ...

Research

JoVE Journal

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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

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The gut-blood barrier (GBB) controls the passage of nutrients, bacterial metabolites and drugs from intestinal lumen to the bloodstream. The GBB integrity ...