Washed Microbiota Transplantation Using Ileocolic Transendoscopic Enteral Tubing Versus Basic Treatments for Intestinal Inflammatory Obstruction in Crohn's Disease: A Multicenter Concurrent Controlled Trial

ABSTRACT Background Surgical intervention becomes necessary when conservative treatments fail in patients with Crohn's disease (CD) complicated by intestinal obstruction. Given the limited therapeutic alternatives, this study aimed to evaluate the efficacy of washed microbiota transplantation (WMT) compared with conventional basic treatment in managing intestinal inflammatory obstruction in CD. Methods In this multicenter, nonrandomized, and concurrent controlled trial, patients with active CD and radiologically confirmed intestinal inflammatory obstruction were enrolled. The WMT group underwent WMT following basic treatment during hospitalization, whereas the non‐WMT group underwent basic treatment alone. Propensity score matching (1:2) was used to balance baseline characteristics. The primary outcome was the obstruction improvement rate at 28 days, with follow‐up continuing until surgery or 3 months post‐discharge. Results Between March 2018 and March 2024, 48 patients were analyzed after matching, with 16 in the WMT group and 32 in the non‐WMT group. The 28‐day obstruction improvement rate was significantly higher in the WMT group (93.8% vs. 65.6%, p = 0.021). For secondary outcomes, the WMT group showed more favorable trends in 14‐day improvement, as well as in clinical remission and surgery rates assessed at 1 and 3 months after discharge, respectively. In contrast, the obstruction remission rate at 1 month post‐discharge was slightly higher in the non‐WMT group. However, none of these differences reached statistical significance. No severe adverse events occurred in the WMT group. Conclusion WMT using ileocolic transendoscopic enteral tubing (TET) offers a safe and effective option bridging surgical intervention and conservative treatments in the management of CD with complicated intestinal inflammatory obstruction. Trail Registration ClinicalTrials.gov NCT01793831, February 2013