Abstract

Background

Several routes of fecal microbiota transplantation (FMT) administration are available for treating recurrent Clostridioides difficile infections (CDI), the most recent of which are capsules.

Aim

To assess the efficacy of colonoscopy, capsule, enema, and nasogastric tube (NGT) FMT for the treatment of recurrent CDI.

Methods

We reported clinical outcomes of colonoscopy, capsule, enema, and NGT FMT for the treatment of recurrent CDI according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. During January 2000 to January 2018, three databases were searched: PubMed, EMBASE, and CINAHL. Primary outcome was overall cure rate which was assessed using a random effects model; secondary outcomes included adverse effects as well as subgroup analyses comparing donor relationship, sample preparation, and study design.

Results

Twenty-six studies (1309 patients) were included in the study. FMT was administered using colonoscopy in 16 studies (483 patients), NGT in five studies (149 patients), enema in four studies (360 patients), and capsules in four studies (301 patients). The random effects of pooled FMT cure rates were colonoscopy 94.8% (CI 92.4–96.8%; I² 15.6%), capsule 92.1% (CI 88.6–95.0%; I² 7.1%), enema 87.2% (CI 83.4–90.5%; I² 0%), and NGT/NDT 78.1% (CI 71.6–84.1%; I² 0%). On subgroup analysis of colonoscopy FMT, sample preparation methods had comparable cure rates: fresh 94.9% compared to 94.5%. Similarly, cure rates were unaffected by donor relationship: mixed 94.5% compared to unrelated donor 95.7%.

Conclusion

CDI cure rates with FMT performed with colonoscopy are superior to enema and NGT FMT, while those with FMT with colonoscopy and capsule are comparable.

中文翻译：

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结肠镜下粪便菌群移植（FMT）优于灌肠和鼻胃管，同时可与胶囊治疗复发性艰难梭菌难治性感染相比：系统评价和荟萃分析

摘要

背景

粪便微生物菌群移植（FMT）的几种给药途径可用于治疗复发性艰难梭菌（Clostridioides difficile）感染（CDI），最近的是胶囊。

目标

评估结肠镜检查，胶囊，灌肠和鼻胃管（NGT）FMT治疗复发性CDI的疗效。

方法

根据系统评价和荟萃分析的首选报告项目，我们报告了结肠镜检查，胶囊，灌肠和NGT FMT治疗复发性CDI的临床结果。在2000年1月至2018年1月期间，搜索了三个数据库：PubMed，EMBASE和CINAHL。主要结局是使用随机效应模型评估的总体治愈率；次要结果包括不良反应以及与供体关系，样品制备和研究设计进行比较的亚组分析。

结果

该研究包括26项研究（1309例患者）。使用结肠镜检查在16项研究（483例患者）中使用FMT，在五项研究（149例患者）中使用NGT，在四项研究（360例患者）中使用灌肠，在四项研究（301例患者）中使用胶囊。合并FMT治愈率的随机影响是结肠镜检查94.8％（CI 92.4–96.8％；I ² 15.6％），胶囊92.1％（CI 88.6–95.0％; I ² 7.1％），灌肠87.2％（CI 83.4–90.5％） ; I ² 0％）和NGT / NDT 78.1％（CI 71.6-84.1％; I ²0％）。在结肠镜检查FMT的亚组分析中，样品制备方法具有相当的治愈率：新鲜的94.9％与94.5％的相比。同样，治愈率不受捐赠者关系的影响：混合比例为94.5％，而无关亲戚的比例为95.7％。

结论

通过结肠镜检查进行FMT的CDI治愈率优于灌肠和NGT FMT，而通过结肠镜检查和胶囊进行FMT的CDI治愈率相当。