CPT® Code 44705

1. Indications

The procedure of fecal microbiota transplantation (FMT) is indicated for patients suffering from recurrent Clostridium difficile infections. This condition often arises after antibiotic treatment, which can disrupt the natural balance of gut bacteria, leading to severe gastrointestinal symptoms. FMT is performed to restore the normal microbiota in the intestines, thereby alleviating the symptoms associated with this infection.

• Recurrent Clostridium difficile infection This is the primary indication for FMT, particularly in cases where standard treatments have failed.

2. Procedure

The procedure for fecal microbiota transplantation involves several critical steps to ensure the safety and efficacy of the treatment. Each step is essential for preparing the fecal microbiota for instillation into the patient.

• Step 1: Donor Selection The first step involves selecting a suitable donor whose stool sample will be used for transplantation. The donor must be screened for infectious diseases, including hepatitis A, B, and C, as well as HIV-1 and HIV-2. Additionally, the donor should be free from parasitic diseases, yeast overgrowth, and other digestive tract conditions that could compromise the safety of the transplant.
• Step 2: Donor Specimen Assessment Once a donor is selected, their stool sample undergoes a thorough assessment. This includes culturing the sample for enteric bacterial pathogens and screening it by light microscopy for the presence of ova and parasites, following standard laboratory protocols to ensure the sample is safe for use.
• Step 3: Sample Preparation After the assessment, the stool sample is prepared for instillation. This preparation involves choosing an appropriate diluent, such as sterile saline, to facilitate the process. The stool is then homogenized to create a uniform mixture and filtered to remove any particulate matter, ensuring that only the beneficial microbiota is administered to the patient.
• Step 4: Administration The final step is the actual administration of the prepared fecal microbiota into the patient’s gastrointestinal tract. This is typically done via enema or nasogastric tube, allowing the microbiota to reach the intestines effectively.

3. Post-Procedure

After the fecal microbiota transplantation procedure, patients are monitored for any immediate adverse reactions. It is essential to observe the patient for signs of infection or gastrointestinal distress. Recovery may vary, but many patients experience a resolution of symptoms associated with Clostridium difficile infection. Follow-up care may include additional monitoring and assessments to ensure the success of the transplant and the restoration of normal gut flora. Patients are also advised on dietary considerations and any necessary lifestyle modifications to support their recovery.