Introduction

Fecal microbiota transplantation (FMT) is an established treatment for Clostridium difficile infection (CDI) and is increasingly explored for other conditions such as inflammatory bowel disease (IBD), autism spectrum disorder (ASD), and metabolic syndromes. Various FMT delivery methods exist, including colonoscopy, enema, nasogastric tube, and oral capsules, with colonoscopy often preferred for its high success rates. This study aimed to assess the safety profile of FMT administered via colonoscopy in pediatric patients.

Aims & Methods

Fecal microbiota transplantation (FMT) has been established as an effective treatment for Clostridium difficile infection (CDI) and is being increasingly explored for other conditions, including inflammatory bowel disease (IBD), autism spectrum disorder (ASD), and metabolic disorders. Various administration routes exist, with colonoscopy often preferred for its efficacy. This study aims to assess the safety profile of FMT via colonoscopy in pediatric patients since data in pediatric population is scarce.
We conducted a retrospective, single-center study at Vilnius University Hospital Santaros Klinikos, reviewing all pediatric FMT procedures performed between 2017 and 2024. Patient data, including demographic information, clinical indications, and post-procedure outcomes, were collected from medical records. All procedures adhered to institutional safety protocols.

Results

A total of 108 FMT procedures were performed on 73 pediatric patients (52 male, 21 female), with a median age of 8.8 years (range: 2.7–17.8 years). The primary indications for FMT included ASD - as part of an ongoing biomedical research (n=84, 77.8%), CDI (n=11, 10.2%), IBD (n=7, 6.5%), and other conditions (n=6, 5.6%). Among CDI cases, 81.8% were associated with underlying IBD. No complications related to anesthesia or the colonoscopy procedure were observed, and no serious adverse events occurred. Mild, self-limiting adverse events, such as transient diarrhea and abdominal discomfort, were reported in 10 cases (9.3%). One patient (0.9%) experienced fever and pharyngitis three days post-procedure, though this was deemed unrelated to FMT.

Conclusion

Our findings suggest that FMT via colonoscopy is a well-tolerated and safe procedure in pediatric patients, with no significant complications and only occasional mild, transient adverse effects. These results support the continued use of FMT as a safe therapeutic option in pediatric care.

Introduction

PEG is a procedure designed to provide prolonged nutritional access for patients who present an intact and/or functional gastrointestinal, but with difficulty or inability to swallow. In pediatric oncology services, PEG is most frequently indicated for children with central nervous system (CNS) tumors and head and neck cancers. While it is well established in clinical practice as an effective and safe method for obtaining enteral access, few studies specifically address the performance of PEG in children with cancer.

Aims & Methods

The main objective of this study is to describe demographic aspects, underlying pathologies, complications, and outcomes of patients who underwent PEG due to cancer. The present study consists in a retrospective cohort of PEG procedures performed in children with any neoplastic diseases that justified a PEG insertion, during the period of October 2000 and January 2018 at the Digestive Endoscopy Unit of the Cancer Hospital I of the Brazilian National Cancer Institute (INCA). Data collection included demographic and pathology baseline information, as well as details regarding post-PEG follow-up and complications. Data extraction was conducted with Excel with further descriptive analyses.

Results

During the study period, a total of 97 children who underwent PEG were included in the study. The mean age was 10.1 years (range: 0.5 to 18.9 years), and fifty-six children (57.7%) were male. The underlying oncological pathologies included 69 cases (71.1%) of neurological tumors, 23 cases (23.7%) of head and neck tumors, 4 cases (4.1%) of hematological malignancies and 1 case of adrenal cortex carcinoma (1%). Fifty-eight patients (59.7%) experienced complications, including granulation tissue formation in 25 cases (25.7%), stoma infection in 6 (8.1%), local pain in 21 (21.6%), bleeding in 3 (3.1%), accidental tube dislodgement in 4 (4.1%), and gastrocolocutaneous fistula in 2 (2.0%). The mean duration of tube placement was 22.1 weeks (range: 0.4 to 483 weeks). At the end of the study, 62 patients had died from their oncological disease (63.9%), 15 patients continued using the tube (15.4%), and 20 patients had the tube removed after completing treatment (20.6%). No cases were lost to follow-up.

Conclusion

PEG is a safe and effective procedure for providing prolonged enteral nutritional access in children with neoplastic disease. Complications are generally classified as minor, and typically do not require invasive treatments.

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