Published online Mar 14, 2023. doi: 10.3748/wjg.v29.i10.1638
Peer-review started: November 19, 2022
First decision: December 10, 2022
Revised: January 15, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 14, 2023
Endofaster is an innovative technology that can be combined with upper gastro
To assess the diagnostic performance of this technology and its impact on the management of H. pylori in the real-life clinical setting.
Patients undergoing routine UGE were prospectively recruited. Biopsies were taken to assess gastric histology according to the updated Sydney system and for rapid urease test (RUT). Gastric juice sampling and analysis was performed using the Endofaster, and the diagnosis of H. pylori was based on real-time ammonium measurements. Histological detection of H. pylori served as the diagnostic gold standard for comparing Endofaster-based H. pylori diagnosis with RUT-based H. pylori detection.
A total of 198 patients were prospectively enrolled in an H. pylori diagnostic study by Endofaster-based gastric juice analysis (EGJA) during the UGE. Biopsies for RUT and histological assessment were performed on 161 patients (82 men and 79 women, mean age 54.8 ± 19.2 years). H. pylori infection was detected by histology in 47 (29.2%) patients. Overall, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for H. pylori diagnosis by EGJA were 91.5%, 93.0%, 92.6%, 84.3%, and 96.4%, respectively. In patients on treatment with proton pump inhibitors, diagnostic sensitivity was reduced by 27.3%, while specificity and NPV were unaffected. EGJA and RUT were comparable in diagnostic performance and highly concordant in H. pylori detection (κ-value = 0.85).
Endofaster allows for rapid and highly accurate detection of H. pylori during gastroscopy. This may guide taking additional biopsies for antibiotic susceptibility testing during the same procedure and then selecting an individually tailored eradication regimen.
Core Tip: Diagnosis of Helicobacter pylori (H. pylori) infection can be rapidly achieved within the framework of gastroscopy by rapid urease test (RUT) or by gastric juice analysis with Endofaster. In this prospective observational study, we compared the accuracy of these two methods. Gastric juice analysis with Endofaster could reliably detect H. pylori with high accuracy, showing a diagnostic performance comparable to that of RUT and a major advantage of an immediate result. Intraprocedural H. pylori detection (or exclusion) is crucial to optimize the diagnostic approach and improve the management of infection. The diagnosis of Endofaster may guide additional sampling for antibiotic susceptibility testing in positive patients or avoid unnecessary biopsies in negative patients.