A procedure where donor stool is transplanted to rebalance the bacteria in the digestive tract to help resolve symptoms.
What is colonoscopy with IMT?
All people need helpful bacteria in their digestive system for it to work properly. Sometimes there is an imbalance of helpful and harmful bacteria. For those with severe or chronic C. difficile colitis, intestinal microbiota transplantation from donor material is used to rebalance the bacteria in the digestive tract to help resolve symptoms. Intestinal microbiota transplant donors are screened and undergo testing for many common communicable diseases to ensure that the procedure is done as safely as possible.
Preparation for colonoscopy with IMT
To produce the best results, you will drink a bowel cleansing preparation to help clean out your colon. Even if your stools are clear, it is important to take all of the colon prep as directed because your body is always making fluid and small polyps can hide behind this fluid.
To ensure the success of your intestinal microbiota transplant (IMT) procedure, you must have your bathroom(s) cleaned. Coming home to an unclean bathroom after your IMT might give C. diff. a chance to infect your gut again. Please see below for specific bathroom cleaning instructions.
What happens during a colonoscopy?
Plan to spend up to 2 hours at the endoscopy suite the day of your colonoscopy. The procedure itself takes about 20-30 minutes to complete.
Before the procedure:
Your medical history will be reviewed with you by your health care team including a nurse and your gastroenterology physician. An IV line will be placed.
During the procedure:
During this procedure, a colonoscope will be inserted into the anus and advanced slowly through the colon. The doctor will inject intestinal transplant material into your colon or terminal ileum through the colonoscope. Your healthcare team will administer medications and monitor vital signs. While most patients sleep through the procedure, some remain awake and aware. If abnormal tissue or polyps are found, the physician will determine if they can be removed safely, though you may be asked to return for another procedure.
What happens after the procedure?
The physician will talk with you about the initial results of your procedure and will prepare a full report for the healthcare provider who referred you for the colonoscopy. You may have some cramping or bloating after the procedure which is normal and should disappear quickly by passing gas.
You may resume most of your regular activities the day after the procedure. However, medication given during the procedure will prohibit you from driving for the rest of the day. You are also advised to avoid air travel for 24 hours following your procedure. You may resume your normal diet, but alcohol should be avoided until the next day after your procedure.
Are there possible complications with colonoscopy?
Although serious complications are rare, any medical procedure has the potential for risks. Risks from the colonoscopy include perforation, or a tear through the lining of the colon, bleeding, reaction to medications, or heart and lung problems.
In addition, there is also a risk from the intestinal microbiota transplant for transmission of infectious organisms (bacterial, viral, fungal, parasitic) contained in the stool; missed polyp, cancer or other lesions; allergic reaction to antigens in donor stool; increased colitis activity in patients with underlying inflammatory bowel disease; and a theoretical risk of developing disease which may be related to donor gut bacteria (obesity/metabolic syndrome, autoimmune conditions, allergic/atopic disorders, neurologic disorders, malignancy).
The use of intestinal microbiota transplantation products to treat C. difficile infection is investigational. IMT donors are screened and tested for many common infections and diseases. It is not possible to test donors for all possible infections. Some infections may not be able to be detected.
Patients with severe C. difficile have a high risk of dying from this condition even with treatment. IMT may not help. Your condition could worsen, improve, or stay the same with IMT.