""Our practice is to administer the very first faecal transplant via a colonoscopy. This only needs to be done once. All the remaining transplants will be performed by rectal enema.
The reason we believe colonoscopy is so important when commencing remicrobialisation is that it allows us to seed the very top of the colon with the new microbiota. This is a critical area to repopulate with good bacteria. It is a long way up the colon, being almost one metre away from the anus and it is where the distal small bowel called the terminal ileum joins the end of the large bowel called the caecum and where the appendix sits.
These three areas, the caecum, the appendix and the terminal ileum are believed to be very important reservoirs or storage houses of good gut bacteria that can be called upon to reconstitute the gut microbiota after an injury such as antibiotics.
The enema FMTs are very effective at implanting a new microbiota but they cannot reach this far up the colon. Therefore, there is concern that enema only FMT may not implant the good bacteria up this far and may miss the ileum, appendix and the caecum. For this reason, we encourage everybody commencing an FMT program to kick off the process of microbiota replacement with the first FMT being performed via a colonoscope.
This will ensure the entire colonic and ileal regions are seeded with the new microbiota. This is the strong recommendation and practice of Prof Tom Borody of CDD, who invented FMT and has achieved the most consistent results to date. We adopt the same opinion. Following your colonoscopy and first FMT all further FMTs will be via enema.""
