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

  • Tongtawee, Taweesak ;
  • Dechsukhum, Chavaboon ;
  • Leeanansaksiri, Wilairat ;
  • Kaewpitoon, Soraya ;
  • Kaewpitoon, Natthawut ;
  • Loyd, Ryan A ;
  • Matrakool, Likit ;
  • Panpimanmas, Sukij
  • Published : 2016.01.11


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.


Site specific biopsy;standard biopsy;Helicobacter pylori infection;premalignant gastric mucosa


  1. CM den Hoed, IL Holster, LG Capelle, et al (2013). Follow-up of premalignant lesions in patients at risk for progression to gastric cancer. Endoscopy, 45, 249-56.
  2. Gono K, Obi T, Yamaguchi M, et al (2004). Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt, 9, 568-77.
  3. Hang Yu, Ai-Ming Yang, Xing-Hua Lu, et al (2015). Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer. World J Gastroenterol, 21, 9156- 62.
  4. Kato T, Yagi N, Kamada T, et al (2013). Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study. Dig Endosc, 25, 508-18.
  5. Kentaro Sugano, Jan Tack, Ernst J Kuipers, et al (2015). Kyoto global consensus report on Helicobacter pylori gastritis. Gut, 64, 1353- 67.
  6. Komoto K, Haruma K, Kamada T, et al (1998). Helicobacter pylori infection and gastric neoplasia: correlations with histological gastritis and tumor histology. Am J Gastroenterol, 93, 1271-6.
  7. Lv X, Wang C, Xie Y, Yan Z, et al (2015). Diagnostic efficacy of magnifying endoscopy with narrow-band imaging for gastric neoplasms: a meta-analysis. PLoS ONE, 10, 1-12.
  8. Mihara M, Haruma K, Kamada T, et al (1999). The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis. Helicobacter, 4, 40-8.
  9. Sugano K, Tack J, Kuipers EJ, et al (2015). Kyoto global consensus report on Helicobacter pylori gastritis. Gut, 64, 1353-67
  10. Taweesak T, Soraya K, Natthawut K, et al (2015). Correlation between Gastric Mucosal Morphologic Patterns and Histopathological Severity of Helicobacter pylori Associated Gastritis Using Conventional Narrow Band Imaging Gastroscopy. Biomed Res Int, 7, 42-8.
  11. Tahara T, Shibata T, Nakamura M, et al (2009). Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis. Gastrointestinal Endosc, 70, 246-53.
  12. Yagi K, Nakamura A, Sekine A, et al (2002). Comparison between magnifying endoscopy and histological, culture and urease test findings from the gastric mucosa of the corpus. Endoscopy, 34, 376-81.
  13. Ying-Ying Hu, Qing-Wu Lian, Zheng-Hua Lin, et al (2015). Diagnostic performance of magnifying narrow-band imaging for early gastric cancer: a meta-analysis. World J Gastroenterol, 21, 7884-94.
  14. Zhang Q, Wang F, Chen ZY, et al (2015). Comparison of the diagnostic efficacy of white light endoscopy and magnifying endoscopy with narrow band imaging for early gastric cancer: a meta-analysis. Gastric Cancer, 1, 1-10.

Cited by

  1. infection vol.21, pp.10834389, 2016,
  2. infection—the Maastricht V/Florence Consensus Report vol.66, pp.1, 2016,
  3. Expression of Cancer Stem Cell Marker CD44 and Its Polymorphisms in Patients with Chronic Gastritis, Precancerous Gastric Lesion, and Gastric Cancer: A Cross-Sectional Multicenter Study in Thailand vol.2017, pp.2314-6141, 2017,
  4. Toll-Like Receptors are Associated with Helicobacter pylori Infection and Gastric Mucosa Pathology vol.In Press, pp.In Press, 2017,
  5. infection after successful treatment vol.47, pp.2, 2019,