Issue link: https://viewer.e-digitaledition.com/i/1109419
cost-effective FMT program because it would be more accessible for patients." Based on outcomes from Children's Hospital Colorado's FMT program, researchers published a retrospective cohort study in The Journal of Pediatrics regarding the cost-effectiveness of pediatric FMT performed via NGT. They found that this approach costs $1,139 on average. That is approximately 85 percent less than FMT performed via colonos- copy ($7,767) and 78 percent less than FMT via nasoduodenal tube ($4,998). "Primarily with colonoscopy, the biggest cost addition is anesthesia or the time in a procedural center," says Edwin de Zoeten, MD, PhD, Director of the Inflammatory Bowel Disease Center at Children's Hospital Colorado and Associate Professor of Pediatrics at the University of Colorado School of Medicine. "As for nasoduodenal tubes, they need to be placed by an interventional radiologist, which adds the cost of another physician, more X-ray time and sometimes sedation, especially for younger kids." NGT placement can be performed by a registered nurse in an outpatient setting, further reducing costs. In addition, Children's Hospital Colorado uses a stool donor bank from a standard commercial laboratory instead of family- provided stool samples, lowering average costs associated with stool donation by 46 percent ($1,154 to $628). Donor banks perform testing in bulk, acquiring multiple stools from a single donor that can be used for numerous procedures, similar to the way blood banks acquire and allocate donations. By comparison, a familial donor undergoes several tests for one procedure on a single patient. "Every familial donor has to be tested for viral and bacterial infections using the proper equipment," Dr. de Zoeten says. "Much of this equipment can't be cleaned and is thrown away [with each donor], which increases the cost." EASE AND EFFICACY NGT procedures are often much less burdensome for patients a nd their fa milies as well. They ta ke only a n hour or t wo a nd don't require chi ldren to endure the bowel-clea ring dia rrhea prepa ration associated with colonoscopies. "Our child life specia lists a re helpful in getting kids to cooperate a nd be actively involved with NGT procedures," Dr. de Zoeten says. In terms of effectiveness, the study found that FMT via NGT successfully treated 94 percent of children with CDI who were other wise hea lthy, 75 percent of children with complex medica l issues a nd 54 percent of chi ldren w ith inf la mmator y bowel disease (IBD). "Ch ron ica l ly i l l ch i ld ren, such a s sol id orga n t ra ns- pla nt recipients or children with oncolog ic diag noses, a re medica l ly fra g i le a nd may be more li kely to get reg u la r courses of a ntibiotics," Dr. Brumbaugh expla ins. " This ca n ha mper FMT eff icacy if prescribed within two months of the procedure." Children with IBD may a lso present sy mptoms of CDI that may not be caused by the C-diff bacteria, which ma kes it more diff icult for resea rchers to determine whether IBD or CDI is the cause of the lower success rate for a ll methods of FMT in children with IBD. The study found FMT via NGT matches the effectiveness of colonoscopy a nd na soduodena l methods w ithin a few percent a ge poi nt s, a lig n i ng w it h f i ndi ngs f rom recent resea rch in Bioscience Horizons. Ca ses t hat may sti l l necessitate colonoscopy include those in which a child is predisposed to vomiting, has facia l or t h roat a natomy t hat wou ld ma ke placement of NGT cha llenging, or is experiencing inf la mmation that inhibits the movement of materia ls in the sma ll bowel a nd colon. n " As much as fecal microbiota transplantation is a standard of care, we still don't know why it works. A theory is that it's the bacteria, but a study [published in Gastroenterology ] filtered out bacteria in the stool, and it was just as effective at stopping C-diff infection. So, it may not be the bacteria. It may be the chemicals and bioacids that are the normal constituents of your gut and part of the digestive process." — DAVID BRUMBAUGH, MD, DIGESTIVE HEALTH INSTITUTE PHYSICIAN AT CHILDREN'S HOSPITAL COLORADO AND ASSOCIATE PROFESSOR OF PEDIATRICS AT THE UNIVERSITY OF COLORADO SCHOOL OF MEDICINE M D N E W S . C O M /// M D N E W S S O U T H C E N T R A L P E N N S Y LVA N I A ■ 2 019 1 5