Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3786-3796
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3786
Awareness and attitude of fecal microbiota transplantation through transendoscopic enteral tubing among inflammatory bowel disease patients
Min Zhong, Yang Sun, Hong-Gang Wang, Cicilia Marcella, Bo-Ta Cui, Ying-Lei Miao, Fa-Ming Zhang
Min Zhong, Cicilia Marcella, Bo-Ta Cui, Fa-Ming Zhang, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Min Zhong, Cicilia Marcella, Bo-Ta Cui, Fa-Ming Zhang, Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Yang Sun, Ying-Lei Miao, Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming 650032, Yunnan, China
Hong-Gang Wang, Medical Center for Digestive Diseases, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Author contributions: Zhang FM designed the study; Zhong M designed the survey and drafted the manuscript; Zhang FM, Cui BT and Marcella C were involved in revision of the manuscript; Zhong M, Sun Y, Wang HG, Marcella C and Miao YL were responsible for the data acquisition; Zhong M conducted the statistical analyses.
Supported by Jiangsu Province Creation Team and Leading Talents Project (to Zhang FM).
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Nanjing Medical University.
Informed consent statement: The study was a survey of patients’ perceptions using questionnaires. Patients were asked if they would like to complete the questionnaire before starting to fill it out. They would only complete the questionnaire if they wanted to. There was no risk to the participants, and no individual patient information was revealed under the condition of anonymity.
Conflict-of-interest statement: Zhang FM invented the concept of transendoscopic enteral tubing and related devices. All other authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fa-Ming Zhang, MD, PhD, Director, Professor, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, No. 121 Jiangjiayuan, Nanjing 210011, Jiangsu Province, China. fzhang@njmu.edu.cn
Received: March 26, 2020
Peer-review started: March 26, 2020
First decision: April 26, 2020
Revised: April 28, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: September 6, 2020

Transendoscopic enteral tubing (TET) has been used in China as a novel delivery route for fecal microbiota transplantation (FMT) into the whole colon with a high degree of patient satisfaction among adults.


To explore the recognition and attitudes of FMT through TET in patients with inflammatory bowel disease (IBD).


An anonymous questionnaire, evaluating their awareness and attitudes toward FMT and TET was distributed among IBD patients in two provinces of Eastern and Southwestern China. Question formats included single-choice questions, multiple-choice questions and sorting questions. Patients who had not undergone FMT were mainly investigated for their cognition and acceptance of FMT and TET. Patients who had experience of FMT, the way they underwent FMT and acceptance of TET were the main interest. Then all the patients were asked whether they would recommend FMT and TET. This study also analyzed the preference of FMT delivery in IBD patients and the patient-related factors associated with it.


A total of 620 eligible questionnaires were included in the analysis. The survey showed that 44.6% (228/511) of patients did not know that FMT is a therapeutic option in IBD, and 80.6% (412/511) of them did not know the concept of TET. More than half (63.2%, 323/511) of the participants stated that they would agree to undergo FMT through TET. Of the patients who underwent FMT via TET [62.4% (68/109)], the majority [95.6% (65/68)] of them were satisfied with TET. Patients who had undergone FMT and TET were more likely to recommend FMT than patients who had not (94.5% vs 86.3%, P = 0.018 and 98.5% vs 87.8%, P = 0.017). Patients’ choice for the delivery way of FMT would be affected by the type of disease and whether the patient had the experience of FMT. When compared to patients without experience of FMT, Crohn’s disease and ulcerative colitis patients who had experience of FMT preferred mid-gut TET (P < 0.001) and colonic TET (P < 0.001), respectively.


Patients’ experience of FMT through TET lead them to maintain a positive attitude towards FMT. The present findings highlighted the significance of patient education on FMT and TET.

Keywords: Recognition, Fecal microbiota transplant, Washed microbiota transplantation, Transendoscopic enteral tubing, Attitude

Core tip: Fecal microbiota transplantation (FMT) has shown its therapeutic potential in inflammatory bowel disease. Transendoscopic enteral tubing (TET) has been used in China as a novel delivery route for FMT. Perception and attitude towards FMT and TET by physicians and patients play an important role in determining its acceptability. We investigated Chinese inflammatory bowel disease patients’ attitude towards FMT and TET and also examined their preference of FMT delivery. This is the first large-scale study of inflammatory bowel disease patients’ perceptions and attitude towards FMT and TET.