Real-time assessment of H. pylori during the endoscopic assessment of individuals with gastric intestinal metaplasia: a possible way to reduce the burden of care

Abstract

Objectives The management of individuals with gastric intestinal metaplasia (GIM) includes biopsies for its staging and to diagnose Helicobacter pylori (Hp). Advanced-stage GIM can be estimated by endoscopy through EGGIM, and a new device permits the real-time assessment of ammonia for the identification of Hp infection. The aim of this study was to assess the simultaneous use of EGGIM and real-time assessment of ammonia to avoid biopsies and reduce the burden of care in clinical practice. Methods A multicentre study involving 101 consecutively enrolled patients [52% male; 65(18–85) years]. During endoscopy, gastric juice was aspirated and analysed; EGGIM was determined in real-time. Targeted biopsies were performed and histopathological assessment was used as gold standard. Results Advanced-stage GIM were detected in 14.9% of patients and Hp infection in 18.8%. EGGIM showed for advanced-stage GIM a sensitivity, specificity and NPV of 86.7%, 84.9% and 97.3%, whilst real-time assessment of ammonia, 83.3%, 78.2% and 95.4%, respectively. Gastric juice was insufficient in 5 (5.0%). Overall, 64 (67%) patients were correctly diagnosed by EGGIM and real-time assessment of ammonia. If the 47 (49%) patients negative to both assessments would have avoided biopsies, only 4 (4.2%) would have been missed: two with advanced-stage GIM and two with Hp infection. Conclusion The combination of endoscopic assessment and real-time analysis of Hp allows the exclusion of advanced-stage GIM or Hp infection without the need of biopsies in a significant proportion of individuals. This may allow in specific situations to abstain from biopsies reducing the burden of care.

Can Gastric Juice Analysis with EndoFaster® Reduce the Environmental Impact of Upper Endoscopy?

“…By considering that a tree absorbs an average of 22 kg of CO 2 per year, the use of EndoFaster ® would correspond to planting 27 trees around an endoscopy center that performs 2000 endoscopies per year. Of note, this reduction can be obtained without losing clinically relevant information for the patients, since EndoFaster ® excludes the presence of both H. pylori infection and diffuse precancerous lesions in the stomach with negative predictive values (NPVs) as high as 97-98% in a population with a low prevalence of these conditions [12,13]. This would mean that only 2-3 of every 100 patients classified as negative by the test would eventually be infected or have a precancerous lesion, even lower when considering that some false-negative results for one finding (i.e., pH results) could be recovered by a positive result at the other finding (i.e., ammonium concentrations).…”

“…In current European guidelines, upper endoscopy is suggested in patients with an increased risk of gastric cancer (patients >50 years old) and in those with alarm symptoms (bleeding, anemia, weight loss, persistent vomiting, dysphagia), while in dyspeptic, uninvestigated young patients, the 13 C-Urea Breath Test (UBT), a less invasive alternative, should be preferred [5,6]. Nevertheless, even when upper endoscopy is appropriate, strategies for GHG emission reduction are needed, which can be summarized in the 3R principle (Reduce, Reuse, Recycle), with the reduction in waste and product generation as the top priority [1,2].…”

“…In line with this perspective, EndoFaster ® (producer: NISO Biomed, Turin, Italy; distributor: Waldner Tecnologie Medicali, Trento, Italy) may be a valid tool to select those patients who really require biopsy sampling of the gastric mucosa, avoiding inappropriate biopsies in low-risk patients and, consequently, reducing the environmental impact. Indeed, EndoFaster ® is an innovative, intuitive, and easy-to-use medical device that automatically analyzes a small (3 mL) amount of gastric juice aspirated during upper endoscopy, allowing one to suspect or rule out both H. pylori infection and diffuse precancerous lesions (atrophy with or without metaplasia) on the gastric mucosa in real time [12,13]. In detail, the machine is interposed between the endoscope and the suction system so that no adjunctive invasive procedure is required and there is no discomfort for the patient (Figure 1).…”

Gastric juice analysis in clinical practice: why, how, and when. The experience with EndoFaster

“…Regarding chronic atrophic gastritis assessment, data from 4 studies with 1017 patients were computed (Table 2) [24,27,,38]. The values of sensitivity, specificity, PPV, NPV, accuracy, positive LR, and negative LR were 83%, 92%, 58%, 97%, 91%, 9.9 and 0.2, respectively.…”