QUARTERLY BEAT / JULY 2024
If no contraindications are present, I use a low dose of acepromazine (0.1 mg/kg) subcutaneously, given 15 minutes before the procedure. Depending on the individual animal’s temper, some clinicians elect not use premedication or sedation before FMT. Our experience is that premedication makes it easier for the dog to relax and rest after the procedure. This allows for a long contact time between the colonic mucosa and the transplant. The FMT procedure is available in Figure 1. FMT can then be administered with the dog in a standing position, sternal or lateral recumbency. It is easiest to insert the catheter with the dogs in a standing position or sternal recumbency. Several types of catheters, such as red rubber catheters, can be used. We use 16 French flexible suction catheters with atraumatic, rounded tips for most dogs and 14 French catheters for cats and toy breeds. ADVERSE EFFECTS Side effects are usually mild and self-limiting. The most prevalent adverse event in our recent publication was self- limiting diarrhoea or worsening of diarrhoea within 48 hrs after FMT. 8 LYOPHILIZED FMT CAPSULES Lyophilized FMT capsules have been proven effective in people and are quick and convenient. No special preparation of the patient is required before administration. Potentially, it may not provide the same booster effect as rectal FMT, as it is difficult for practical reasons to give the equivalent amount of faeces in capsules as one rectal FMT. Commercial lyophilized capsules provide less information on the microbial composition of the donor stool compared to screened donors from your own fecal bank. In people with ulcerative colitis, the microbial composition of donor stool has been associated with outcome. 2 GASTROINTESTINAL INDICATIONS FOR FMT FMT has saved the life of several of the author's canine patients with non-responsive or poorly responsive CE. In dogs with CE responding to FMT, FMT will not “cure” the dogs, but the disease activity and maintenance doses of concurrent medication
Frozen faeces should be thawed in a 37°C water bath on the day of the procedure or thawed in a fridge overnight. After blending with saline, the volume of the transplant should not exceed 20 ml/kg BW of the recipient.
Remove solid pieces (grass, gravel etc.) from donor faeces
Blend faeces with saline 1:1-1:3 to a suitable texture using a blender a
Filtrate transplant with a sieve or cheese cloth, aspirate in 60 ml syringes
Measure the catheter - the tip should be at level of the last rib of the donor
Attach catheter to syringe and fill the catheter with faeces
Lubricate the catheter, insert it rectally until it reaches the level of the last rib
Give the transplant. Hold one hand firmly on the base of the catheter b
Remove the catheter
Instruct the dog owner to restrict walks and food for the next 4-6 hrs
a Typically the texture of a ”thick smoothie” or purée b This prevents leakage and detachment of the syringe from the catheter
RECTAL FMT PROCEDURE Prior to the procedure, the recipient dog should be walked for 30-40 minutes in order to defecate. Bowel cleansing is not needed.
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