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
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.
The diagnostic performance of the Endofaster has not been compared with that of the RUT, which shares a similar characteristic in terms of providing results in a short-term temporal context through endoscopic examination.
The objective of this prospective study was to validate the diagnostic performance of the Endofaster for H. pylori detection in patients who underwent gastroscopy compared to the diagnostic accuracy of a standard RUT.
Patients undergoing routine upper gastrointestinal endoscopy were prospectively recruited. Biopsies were taken to assess gastric histology according to the updated Sydney system and for 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.
Gastric juice analysis with Endofaster could reliably detect H. pylori with an overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 91.5%, 93.0%, 92.6%, 84.3%, and 96.4%, respectively. Gastric juice analysis with Endofaster and RUT were comparable in diagnostic performance and highly concordant in H. pylori detection (κ-value = 0.85).
Endofaster’s gastric juice analysis is a highly accurate method for the diagnosis of H. pylori infection, comparable to RUT. EGJA-based H. pylori diagnosis has an advantage in terms of on-site immediacy of diagnosis.
Intraprocedural diagnosis of H. pylori-infection by Endofaster may guide additional sampling for antibiotic susceptibility testing in positive patients or avoid unnecessary biopsies in negative patients.