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Diversion ColitisNCT07674186

Autologous Fecal Microbiota Transplantation for Diversion Colitis

A study testing Autologous Fecal Microbiota Transplantation (auto-FMT) and saline irrigation in people with Diversion Colitis, run by Yongjian Liao at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Diversion colitis (DC) is a common inflammatory complication in patients with temporary ileostomy after rectal cancer surgery, and no standardized medical treatment exists. This prospective, assessor-blinded, parallel-group, randomized controlled trial evaluated whether autologous fecal microbiota transplantation… Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Diversion Colitis
What is being tested?
Autologous Fecal Microbiota Transplantation (auto-FMT) and saline irrigation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
66 participants
Where
1 siteChina
Study dates
1 Jun 2022to 30 Sep 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histopathologically confirmed rectal adenocarcinoma.
  • Low anterior resection with temporary loop ileostomy.
  • Age 18-75 years.
  • Scheduled for ileostomy reversal at 3-6 months after primary surgery.
  • Endoscopic confirmation of diversion colitis at week 4 post-ileostomy (modified Harig score ≥4, range 0-12).
  • Written informed consent.

Who cannot join

  • Neoadjuvant chemoradiotherapy.
  • Pre-existing inflammatory bowel disease, irritable bowel syndrome, or chronic constipation.
  • Previous colorectal surgery (other than index surgery).
  • Active infection requiring systemic antibiotics within 4 weeks before enrollment.
  • Use of probiotics, prebiotics, or antibiotics within 4 weeks before enrollment.
  • Severe organ dysfunction (Child-Pugh B/C cirrhosis, end-stage renal disease).
  • Pregnancy or lactation.
  • Any condition precluding protocol compliance or outcome assessment.

Trial locations and contacts

1 site in 1 country.

China1 site
  • Department of Colorectal Surgery, The First People's Hospital of Lin'an District, Hangzhou

    Hangzhou, Zhejiang, 311300

Other trials in China

About this study

Official title: Autologous Fecal Microbiota Transplantation Via the Diverting Stoma Ameliorates Diversion Colitis in Patients With Temporary Ileostomy for Rectal Cancer: A Randomized Controlled Trial With Endoscopic and Histopathological Assessment

Diversion colitis (DC) is a common inflammatory complication in patients with temporary ileostomy after rectal cancer surgery, and no standardized medical treatment exists. This prospective, assessor-blinded, parallel-group, randomized controlled trial evaluated whether autologous fecal microbiota transplantation (auto-FMT) delivered through the diverting stoma ameliorates DC and improves post-reversal outcomes. Sixty-six patients with endoscopically confirmed DC were randomized 1:1 to receive daily auto-FMT (n=33) or saline irrigation (n=33) for four weeks. The primary endpoints are changes from baseline to week 4 in endoscopic (modified Harig score, 0-12) and histopathological (0-9) scores. Secondary endpoints include Wexner incontinence score, quality of life (EORTC QLQ-C30/CR29), inflammatory biomarkers, and safety. The study is designed to test whether auto-FMT produces superior improvements in endoscopic and histopathological severity compared with saline control, and leads to better functional outcomes after stoma reversal.

Read the detailed description

Background and Rationale

Diversion colitis frequently develops after fecal stream diversion, affecting most patients whose intestinal continuity remains interrupted for more than three to six months. While stoma reversal is definitive, many patients require prolonged diversion due to adjuvant chemotherapy, poor general condition, or anastomotic healing concerns. Existing medical therapies-including short-chain fatty acid enemas, 5-aminosalicylates, corticosteroids, and probiotics-lack consistent efficacy in randomized trials. Gut microbiota dysbiosis is a central driver of DC; restoring a diverse microbial community via fecal microbiota transplantation represents a rational approach. Autologous FMT using the patient's own stoma effluent avoids pathogen transmission, donor screening, and ethical concerns. However, no prospective RCT has systematically evaluated auto-FMT for DC using endoscopic and histopathological endpoints.

Study Design

Single-center, prospective, assessor-blinded, parallel-group, superiority randomized controlled trial with a 1:1 allocation ratio.

Participants

Adults aged 18-75 years with histopathologically confirmed rectal adenocarcinoma who underwent low anterior resection with temporary loop ileostomy, scheduled for reversal at 3-6 months after primary surgery, and with endoscopic DC (modified Harig score ≥4 at week 4 post-ileostomy). Key exclusion criteria: neoadjuvant chemoradiotherapy, pre-existing inflammatory bowel disease, recent antibiotic or probiotic use, severe organ dysfunction, pregnancy, or lactation.

Interventions

Auto-FMT group: Daily irrigations of autologous fecal microbiota suspension for 4 weeks. Preparation: 50-80 g of fresh stool collected from the patient's stoma bag within 2 hours of passage, homogenized with 500 mL sterile normal saline (0.9% NaCl) pre-warmed to 37°C, stirred, and filtered through two layers of sterile gauze. The filtrate was used within 30 minutes. Irrigation: a 14-16 French Foley catheter inserted 10-15 cm into the efferent limb of the loop ileostomy; suspension infused by gravity drip over 5-10 minutes; patients retained the suspension for at least 30 minutes before evacuation.

Control group: Daily irrigations of 500 mL sterile normal saline (37°C) using the same catheter and technique, with the same retention time.

Outcome Measures

Primary outcomes: Change from baseline to week 4 in endoscopic score (modified Harig score, 0-12) and histopathological score (composite of mucosal atrophy, crypt distortion, and inflammatory infiltrate, 0-9), assessed by blinded reviewers.

Secondary outcomes: Wexner incontinence score at 1, 3, and 6 months after stoma reversal; quality of life (EORTC QLQ-C30 and QLQ-CR29) at baseline, week 4, and 6 months post-reversal; serum hs-CRP, albumin, and fecal calprotectin at baseline and week 4; adverse events (CTCAE v5.0); treatment adherence (≥80% of 28 sessions).

Sample Size

33 patients per group (total 66) to detect a mean endoscopic score reduction difference of 1.5 points (assuming SD 2.0 in auto-FMT group and SD 1.8 in control group), 80% power, two-sided α = 0.05, accounting for a 20% dropout rate.

Statistical Analysis

Primary analysis was intention-to-treat. Change scores were analyzed using ANCOVA with baseline score as covariate. Secondary outcomes: Wexner scores with generalized estimating equations; quality of life with ANCOVA; biomarkers with Mann-Whitney U tests. Missing data were handled with multiple imputation. Two-tailed p < 0.05 was considered significant.

Ethical Approval

The protocol was approved by the Ethics Committee of Lin'an First People's Hospital, Hangzhou (Approval No.: Lin'an First People's Hospital Lun Yan Shen 2022 No.20, dated April 29, 2022). Written informed consent was obtained from all participants. The study followed the Declaration of Helsinki.

Being tested
Autologous Fecal Microbiota Transplantation (auto-FMT), saline irrigation
Keywords
Autologous Fecal Microbiota Transplantation, Diversion Colitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Autologous Fecal Microbiota Transplantation (auto-FMT)Other

    Daily irrigation of autologous fecal microbiota suspension via the diverting stoma for 4 weeks.

  • saline irrigationOther

    Daily irrigation of 500 mL sterile normal saline (0.9%) at 37°C via the diverting stoma, using the same catheter and technique as the auto-FMT group.

Study groups in NCT07674186
Study groupRoleWhat they receive
Autologous Fecal Microbiota Transplantation (auto-FMT)ExperimentalDaily irrigations of autologous fecal microbiota suspension via the diverting stoma for 4 weeks. Preparation: 50-80 g of fresh stool collected from the patient's stoma bag within 2 hours of passage, homogenized with 500 mL of sterile normal saline (0.9% NaCl) pre-warmed to 37 °C, stirred, and filtered through two layers of sterile gauze. The filtrate is used within 30 minutes. Irrigation: A 14-16 French Foley catheter inserted 10-15 cm into the efferent limb of the loop ileostomy, balloon inflated with 5-8 mL of air. The suspension is infused by gravity drip (bag 40-50 cm above stoma) over 5-10 minutes. Patients retain the suspension for at least 30 minutes before evacuation. Vital signs are monitored for the first 3 days.
Receives: Other: Autologous Fecal Microbiota Transplantation (auto-FMT)
Saline IrrigationOtherDaily irrigations of 500 mL sterile normal saline (0.9% NaCl) pre-warmed to 37 °C via the diverting stoma for 4 weeks. A 14-16 French Foley catheter is inserted 10-15 cm into the efferent limb of the loop ileostomy, and the balloon is inflated with 5-8 mL of air. Saline is infused by gravity drip (bag 40-50 cm above stoma) over 5-10 minutes. Patients retain the saline for at least 30 minutes before evacuation.
Receives: Other: saline irrigation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Endoscopic Score

    Change from baseline to week 4 in modified Harig score (0-12), evaluating edema/erythema, loss of vascular pattern, friability/contact bleeding, and erosions/ulcerations (each 0-3). Higher scores indicate more severe inflammation. A blinded colorectal endoscopist performed colonoscopy through the stoma at week 0 and week 4.

    Measured: Baseline and Week 4

  2. Change in Histopathological Score

    Change from baseline to week 4 in composite histopathological score (0-9), assessing mucosal atrophy, crypt distortion, and inflammatory infiltrate (each 0-3). The average score of two blinded gastrointestinal pathologists was used; disagreements (>2 points) were resolved by joint review.

    Measured: Baseline and Week 4

Secondary outcomes (7)
  1. Wexner Incontinence Score

    Wexner incontinence score (0-20, where 0 = perfect continence, 20 = complete incontinence) assessed at 1, 3, and 6 months after stoma reversal.

    Measured: Month 1, Month 3, Month 6 post-reversal

  2. Quality of Life - EORTC QLQ-C30 Global Health Status

    Global health status / quality of life score from the EORTC QLQ-C30 questionnaire. Higher scores indicate better quality of life.

    Measured: Baseline, Week 4, and Month 6 post-reversal

  3. Quality of Life - EORTC QLQ-CR29

    Disease-specific quality of life assessed by the EORTC QLQ-CR29 module, covering symptoms and functioning domains relevant to colorectal cancer patients.

    Measured: Baseline, Week 4, and Month 6 post-reversal

  4. Serum hs-CRP Level

    High-sensitivity C-reactive protein (hs-CRP) measured in mg/L from serum samples.

    Measured: Baseline and Week 4

  5. Serum Albumin Level

    Albumin concentration measured in g/L from serum samples.

    Measured: Baseline and Week 4

  6. Fecal Calprotectin Level

    Fecal calprotectin concentration measured by ELISA (μg/g), as a biomarker of intestinal inflammation.

    Measured: Baseline and Week 4

  7. Adverse Events and Treatment Adherence

    Adverse events graded according to CTCAE v5.0 (incidence, severity, and causality). Treatment adherence defined as completion of ≥80% of 28 scheduled irrigation sessions.

    Measured: Throughout the 4-week intervention period for adverse events; at end of intervention for adherence

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jun 2026
  2. Study start1 Jun 2022
  3. Primary completion31 Mar 2025
  4. Study completion30 Sep 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
66 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07674186
Sponsor's protocol ID
2022-YJ-020
Status last verified
Jun 2026
First submitted
15 Jun 2026
Last updated
29 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual participant data underlying the results reported in this manuscript will be made available to researchers who provide a methodologically sound proposal, for the purpose of individual participant data meta-analysis or other approved research. The study protocol, statistical analysis plan, and informed consent form will also be available. Data will be accessible immediately after publication, upon reasonable request to the corresponding author.

Publications

  • Wang JW, Kuo CH, Kuo FC, Wang YK, Hsu WH, Yu FJ, Hu HM, Hsu PI, Wang JY, Wu DC. Fecal microbiota transplantation: Review and update. J Formos Med Assoc. 2019 Mar;118 Suppl 1:S23-S31. doi: 10.1016/j.jfma.2018.08.011. Epub 2018 Sep 1.

    PubMed 30181015
  • Sam SW, Hafeez B, Ong HI, Gill S, Smibert O, Lavelle A, Burgess A, Proud D, Mohan H. The impact of faecal diversion on the gut microbiome: a systematic review. Gut Microbiome (Camb). 2024 Feb 19;5:e4. doi: 10.1017/gmb.2024.1. eCollection 2024.

    PubMed 39290660
  • Sohara N, Hagiwara S, Arai R, Iizuka H, Onozato Y, Kakizaki S. Can endoscopic submucosal dissection be safely performed in a smaller specialized clinic? World J Gastroenterol. 2013 Jan 28;19(4):528-35. doi: 10.3748/wjg.v19.i4.528.

    PubMed 23382632
  • Vajn K, Suler D, Plunkett JA, Oudega M. Temporal profile of endogenous anatomical repair and functional recovery following spinal cord injury in adult zebrafish. PLoS One. 2014 Aug 26;9(8):e105857. doi: 10.1371/journal.pone.0105857. eCollection 2014.

    PubMed 25157957

Questions about this trial

What is this clinical trial studying?

A study testing Autologous Fecal Microbiota Transplantation (auto-FMT) and saline irrigation in people with Diversion Colitis, run by Yongjian Liao at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Endoscopic Score (time frame: Baseline and Week 4). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07674186, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jun 2026.

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