Improved Detection of Helicobacter pylori Infection and Premalignant Gastric Mucosa Using "Site Specific Biopsy": a Randomized Control Clinical Trial

Abstract

Background: Helicobacter pylori infection and premalignant gastric mucosa can be reliably identified using conventional narrow band imaging (C-NBI) gastroscopy. The aim of our study was to compare standard biopsy with site specific biopsy for diagnosis of H. pylori infection and premalignant gastric mucosa in daily clinical practice. Materials and Methods: Of a total of 500 patients who underwent gastroscopy for investigation of dyspeptic symptoms, 250 patients underwent site specific biopsy using C-NBI (Group 1) and 250 standard biopsy (Group 2). Sensitivity, specificity, and positive and negative predictive values were assessed. The efficacy of detecting H. pylori associated gastritis and premalignant gastric mucosa according to the updated Sydney classification was also compared. Results: In group 1 the sensitivity, specificity, positive and negative predictive values for predicting H. pylori positivity were 95.4%, 97.3%, 98.8% and 90.0% respectively, compared to 92.9%, 88.6%, 83.2% and 76.1% in group 2. Site specific biopsy was more effective than standard biopsy in terms of both H. pylori infection status and premalignant gastric mucosa detection (P<0.01). Conclusions: Site specific biopsy using C-NBI can improve detection of H. pylori infection and premalignant gastric mucosa in daily clinical practice.

Diagnostic of Helicobacter pylori infection

“…The degree of correspondence between the two methods was 89.1% . Furthermore, NBI enables the sampling of targeted biopsies (“site specific”) vs standard site biopsies; this method was shown to be more effective for both detection of H. pylori and detection of premalignant lesions …”

“…7 Furthermore, NBI enables the sampling of targeted biopsies ("site specific") vs standard site biopsies; this method was shown to be more effective for both detection of H. pylori and detection of premalignant lesions. 8 Confocal laser endomicroscopy allows a microscopic visualization of the mucosa during endoscopy at an approximately 1000-fold magnification which results in an optimized diagnosis of gastric atrophy and intestinal metaplasia as well as limiting the sampling error of untargeted biopsies. 9 While more useful for the esophagus, it can be used for grading premalignant lesions of the stomach with even higher accuracy than NBI or chromoendoscopy.…”

Precancerous Gastric Lesions with Helicobacter pylori vacA+/babA2+/oipA+ Genotype Increase the Risk of Gastric Cancer

“…Written informed consent was obtained from all patients, and the study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Suranaree University of Technology (EC-59-45 and EC 16-2560). e whole stomach was examined and biopsies were conducted using the site-specific biopsy technique [40]. All biopsies were directly tested for H. pylori infection by using the rapid urease test (RUT) kit (Pentland Medical, Edinburgh, UK).…”

Advanced endoscopic imaging in gastric neoplasia and preneoplasia

“…On a similar note, Tongtawee et al 's38 study of 200 patients demonstrated that NBI also reliably identifies gastric mucosal morphological patterns associated with H. pylori infection, which correlated significantly with severity of pathological inflammation grading. A subsequent randomised study39 on 500 subjects noted site-specific biopsy guided by NBI had higher yield of diagnosing Helicobacter , as compared with standard WLE biopsy. Findings by Ang and Tongtawee suggest that NBI would be useful to identify sites for high-yield targeted biopsies.…”