Huang Changjiang, Huang Cheng, Tian Renfu, Pu Yungang, Chen Pengfei
Intensive Care Unit, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
Gastroenterology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
Heliyon. 2024 Jun 26;10(13):e33678. doi: 10.1016/j.heliyon.2024.e33678. eCollection 2024 Jul 15.
Gut microbiota dysbiosis plays a significant role in the development of acute pancreatitis (AP). However, a recent randomized trial reported negative findings regarding the use of fecal microbiota transplantation (FMT) via the mid-gut tube in severe AP. The case series presents the feasibility of washed microbiota transplantation (WMT) as a new methodology of FMT and its delivery via colonic transendoscopic enteral tubing (TET) for severe AP.
We presented two cases of severe AP rapidly rescued using WMT via colonic TET. Symptoms related to severe AP and the acute physiology and chronic health evaluation-II score improved soon after WMT. In Case 1, bilirubin and infection indexes continuously decreased after the initial WMT and the patient was successfully weaned off the ventilator and recovered from multiple organ system failures (MSOF) within ten days. In Case 2, the patient's consciousness rapidly improved within one day after WMT, with normal bowel sounds and stable blood pressure without vasoactive drug maintenance. Both Case 1 and Case 2 completed follow-ups of seven months and twenty-two months, respectively, with no reports of new-onset diabetes.
WMT via colonic TET played a critical therapeutic role in rescuing severe AP cases. This is the first report providing direct evidence for the clinical value of targeting microbiota through colonic TET in rescuing severe AP.
肠道微生物群失调在急性胰腺炎（AP）的发展中起重要作用。然而，最近一项随机试验报告了关于在重症急性胰腺炎中通过中肠管进行粪便微生物群移植（FMT）的阴性结果。本病例系列展示了经结肠经内镜肠内导管（TET）进行洗过的微生物群移植（WMT）作为FMT的一种新方法及其用于重症急性胰腺炎的可行性。
我们报告了两例通过经结肠TET进行WMT迅速获救的重症急性胰腺炎病例。重症急性胰腺炎相关症状以及急性生理学与慢性健康状况评分-II在WMT后很快得到改善。在病例1中，首次WMT后胆红素和感染指标持续下降，患者在十天内成功脱机并从多器官系统衰竭（MSOF）中康复。在病例2中，患者在WMT后一天内意识迅速改善，肠鸣音正常，血压稳定，无需血管活性药物维持。病例1和病例2分别完成了七个月和二十二个月的随访，均无新发糖尿病的报告。
经结肠TET进行的WMT在抢救重症急性胰腺炎病例中发挥了关键的治疗作用。这是第一份为通过结肠TET靶向微生物群在抢救重症急性胰腺炎中的临床价值提供直接证据的报告。
