title: Endoscopic peroral jejunal fecal microbiota transplantation.
abstract: BACKGROUND
  Fecal microbiota transplantation (FMT) is a valuable treatment modality for recurrent Clostridium difficile (C. difficile) colitis. Multiple questions including the best delivery route and volume remain unanswered. Here, we report a case series of high-volume FMT using endoscopic jejunal application route.
  
  
  METHODS
  In prospective observational study, FMT was performed using fresh specimen from healthy unrelated donors to the patients with recurrent or refractory C. difficile colitis. Selection of the route was based on the patient's preferences. Specimens of at least 50g were dissolved in 500ml of electrolyte solution and administered using endoscope directly in jejunum.
  
  
  RESULTS
  All procedures led to cure of C. difficile colitis. With exception of one case the procedure was well tolerated. In two cases, we observed FMT-reflux into the stomach despite deep jejunal application and in single case the FMT-reflux led to tracheal aspiration and severe pneumonia.
  
  
  CONCLUSIONS
  High-volume FMT via endoscopic jejunal route is an effective treatment option that is well tolerated and easy to perform. Nevertheless, aspiration is potential life-threatening event that needs to be kept in mind during the FMT-procedure.
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany. Electronic address: alexander.link@med.ovgu.de.
authors: Alexander
authors: A
authors: Link
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
authors: Tim
authors: T
authors: Lachmund
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
authors: Christian
authors: C
authors: Schulz
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
authors: Jochen
authors: J
authors: Weigt
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
authors: Peter
authors: P
authors: Malfertheiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003015:Clostridium Infections / Q000628:therapy*; D004724:Endoscopy; D000069467:Fecal Microbiota Transplantation / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D007583:Jejunum / Q000382:microbiology*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
keywords: Application; Aspiration; Endoscopy; Fecal microbiota transplantation