Methodology Of Colonic Approach For Endoscopic Intestinal Catheterization And Its Value For Decontamination Microbiota Transplantation

Background and Aim:Colonic transendoscopic enteral tubing(TET)as a novel intestinal intervention technique has a series of unsolved problems.The procedure of colonic TET requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET procedure.To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).Methods:This prospective multicenter,randomized controlled trial was performed at four centers.Subjects ? 7 years needing colonic TET were recruited from August 2018 to January 2020.All subjects were randomly assigned to two groups.The primary outcome was the second cecal intubation time.Secondary outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedure related(serious)adverse events.Results:A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)group.The median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8 ± 1.7 vs 5.4 ± 1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]=2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult colonoscopy.CC did not affect the colonic TET tube's retention time and length of the tube inserted into the colon.Moreover,multivariate analysis found that only endoscopic clip number(OR=2.201,95%CI:1.541-3.143;P<0.001)was an independent factor affecting the retention time.Multiple regression analysis showed that height(OR=1.144,95%CI:1.027-1.275;P=0.014)was the only independent factor influencing the length of TET tube inserted into the colon in adults.Conclusions:CC for colonic TET procedure is a safe and less painful technique,which can reduce cecal intubation time.Background and Aim:Colonic transendoscopic enteral tubing(TET)as a promising colonic delivering of multiple washed microbiota transplantations(WMTs)and colonic medication administration is particularly important for Ulcerative colitis(UC)patients.However,the factors affecting the retention time of colonic TET tube in UC patients are not clear.To evaluate the method of colonic TET for UC as a new colonic interventional delivering for WMT or medications,and to analyze influencing factors on retention time of TET tube.Methods:This prospective study included UC patients who underwent colonic TET for WMT and/or colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2015 to February 2021.The TET procedure time,success rate,adverse events and satisfaction degree,as well as the retaining time of TET tube were recorded,and the influencing factors of TET tube retaining time were evaluated.Results:A total of 330 UC patients underwent colonic TET.The TET tubes were used in 320 patients(97.0%)for WMT,301 patients(91.2%)for medication.The mean TET procedure time was(8.6 ± 2.9)min.The success rate of the TET procedure was 100%.The median retaining time of TET tube was 8(7-10)days in 295 patients with the tube falling out naturally.In patients with large endoscopic clips,the retaining time of TET tube was significantly prolonged with the increased number of large endoscopic clips(n=1-4,P=0.002).The retaining time of TET tube in the large endoscopic clip group was obviously longer than that in the small clip group,when the number of endoscopic clips used was the same(n=3 or 4)(P<0.05).According to the median retention time of the TET tube,293 patients with tube falling out naturally who did not mix using two types clips were divided into short-term retention group(?8 days)and long-term retention group(>8 days).Univariate and multivariate analysis indicated that the type(OR=0.098,95%CI:0.030-0.322,P=0.000)and number(OR=0.483,95%CI:0.339-0.687,P=0.000)of endoscopic clips were the influencing factors for the retaining time of tube.No severe adverse event was observed during and after TET.The satisfaction degree on colonic TET was 98.5%(322/327).Conclusions:Colonic TET as a promising colonic delivering of multiple WMT and frequent colonic medication administration for UC patients is safe,practical and feasible.