“Efficacy and feasibility of Narrow Band Imaging Endoscopy for detection of Helicobacter Pylori Infection” (2).pptx

This is a thesis on the efficacy and feasibility of narrow band imaging for detection of Helicobacter Pylori

1. Efficacy and feasibility of Narrow Band Imaging Endoscopy in the real time detection of active Helicobacter Pylori Infection-A Prospective Observational Analytical Study.

2. Dr. Sidney Palha Junior Resident in General Surgery, Goa Medical College. Guide: Dr.C.G.Radhika Raj , Associate Professor in General Surgery, Goa Medical College.

3. Up to 50% of the world’s population, 85%-95% in developing countries may be infected with the Gram negative bacterium Helicobacter Pylori. 1 H. Pylori infection is present in 58% patients with functional dyspepsia 2 Helicobacter pylori infections are associated with significant morbidity. It is a common cause of gastritis and a major risk factor for the development of diseases like peptic ulcers, gastric adenocarcinomas and mucosa-associated lymphoid tissue lymphomas 3 The diagnosis of H. pylori can be obtained by using non-invasive methods (urea breath test and stool antigen tests) and Invasive methods (tissue culture, rapid urease test, polymerase chain reaction, and histology). Narrow Band Imaging is a novel endoscopy technique whose diagnostic accuracy in detecting H Pylori needs evaluation.

4. AIMS & OBJECTIVES Primary Objective: To evaluate the use of Narrow Band Imaging Endoscopy for detection of H pylori Secondary Objective: To identify the incidence of H Pylori in patients presenting with dyspepsia. To study the factors influencing H. Pylori detection.

5. MATERIALS & METHODS: STUDY DESIGN: Prospective Observational Analytical Study DURATION OF STUDY: 12 months (after IEC approval) STUDY SETTING: OPD and Endoscopy room of Dept of Surgery in GMC STUDY PARTICIPANTS: All Adult Patients presenting to General Surgery Department with features of dyspepsia who undergo upper GI endoscopy SAMPLE SIZE: 178 patients. SAMPLING TECHNIQUE: Systematic Random Sampling STUDY TOOLS: Pretested semi-structured questionnaire, Urease Kit Test and Endoscope

6. Inclusion and Exclusion Criteria INCLUSION: All patients, Male and Female, more than 18 years of age presenting to General Surgery Department with symptoms of dyspepsia. EXCLUSION: Patients not giving consent. Patients having upper GI Bleed Patients on Proton Pump Inhibitors in the last 2 weeks. Patients who have undergone H. Pylori eradication recently Patients who underwent gastric surgery in the past. Patients on NSAIDs

7. ENDOSCOPE BLI (Blue Light Imaging) Imaging Technology

8. 2. UREASE KIT TEST Principle: Detects change in pH due to NH3 Duration of results: 24 hours The sensitivity and specificity of Urease test when compared with histology were 89% and 88% respectively. 5

9. Methods: Lorem ipsum Dolor nec Ipsum dolor amet dolor Lorem ipsum dolor sit amet nec at adipiscing risus at dolor porta 1 Lorem ipsum dolor sit amet nec at adipiscing Lorem ipsum dolor sit amet nec at adipiscing risus at dolor porta 2 Lorem ipsum dolor sit amet nec at adipiscing Lorem ipsum dolor sit amet nec at adipiscing risus at dolor porta 3 Lorem ipsum dolor sit amet nec at adipiscing NBI ENDOSCOPY UREASE KIT TEST H PYLORI POSITIVE 1 H PYLORI POSITIVE 3 FURTHER ANALYSIS WITH HISTOPATHOLOGY 2

10. STATISTICAL ANALYSIS Data of all cases satisfying inclusion and exclusion criteria will be entered in a proforma taking into account detailed clinical history, general & systemic examination and Test Results. The data gathered on Excel Sheet, Microsoft. For assessing the accuracy of NBI we will be comparing the test with Urease Kit Test taken as reference standard. Sensitivity, Specificity, PPV and NPV will then be calculated using a 2x2 table. The data gathered will be analyzed using the Statistical Package for Social Science (SPSS, IBM version 25) and Chi Square Test. Urease Kit Test POSITIVE Urease Kit Test NEGATIVE Narrow Band Imaging POSITIVE A B Narrow Band Imaging NEGATIVE C D

11. PROFORMA Name: Age: Sex: H No: Date of Endoscopy: PRESENTING FEATURES Abdominal pain Abdomen fullness Vomiting Bloating Indigestion GENERAL EXAMINATION SYSTEMIC EXAMINATION Urease Kit Test Result:- POSITIVE/NEGATIVE Endoscopy Test Result:- POSITIVE/NEGATIVE If urease Kit Test negative and Endoscopy test is positive then Biopsy Test Result:- POSITIVE/NEGATIVE ENDOSCOPY Findings Procedure

12. INFORMED CONSENT Study Title : Efficacy and feasibility of Narrow Band Imaging Endoscopy for detection of Helicobacter Pylori Infection I, ______________________________________________, Voluntarily agree to participate in this study. I understand that the study will involve : Collection of Personal and Clinical Details. Collection of Tissue Ssample I understand that the data generated out of my participation in the study will be used for research/ thesis purposes and will be kept confidential. I confirm that I have not been offered any financial incentive to participate in this study . I am also aware that I can withdraw from the study at any point of time without stating any reasons for it , without my right being affected.

13. Bibliography 1. Bailey and Love’s Short Practice of Surgery, 27th Edition, Part 11, Chapter 63, page 1114 2. Rodriguez JL, Functional dyspepsia and dyspepsia associated with Helicobacter pylori infection: REVISTA DE GASTROENTEROLOGIA MEXICO Volume 81, Issue 3,2016,Pages 126-133 3. Malfertheiner P, Venerito M, Schulz C. Helicobacter pylori Infection: New Facts in Clinical Management. Curr Treat Options Gastroenterol. 2018;16:605–615. 4. Chen T, et al “Linked color imaging can help gastric Helicobacter pylori infection diagnosis during endoscopy” Journal of the Chinese Medical Association 81 (2018) 1033-1037 5. Chou CH, Sheu BS, Yang HB, Cheng PN, Shin JS, Chen CY, Lin XZ. Et al “ Clinical assessment of the bacterial load of Helicobacter pylori on gastric mucosa by a new multi-scaled rapid urease test” J Gastroenterol Hepatol. 1997;12:1–6 6. de Brito BB, da Silva FAF, Soares AS, Pereira VA, Santos MLC, Sampaio MM, Neves PHM, de Melo FF. Pathogenesis and clinical management of Helicobacter pylori gastric infection. World J Gastroenterol. 2019 Oct 7;25(37):5578-5589.

14. Conclusion NBI seems to be a promising method for H. Pylori infection identification. New diagnostic methods should be better explored in order to provide diagnostic alternatives to doctors

15. THANK YOU.

16. Bibliography Bailey and Love’s Short Practice of Surgery, 27th Edition, Part 11, Chapter 63, page 1114 “Functional dyspepsia and dyspepsia associated with Helicobacter pylori infection: Do they have different clinical characteristics?”Volume 81, Issue 3,2016,Pages 126-133 Malfertheiner P, Venerito M, Schulz C. Helicobacter pylori Infection: New Facts in Clinical Management. Curr Treat Options Gastroenterol. 2018;16:605–615. “Linked color imaging can help gastric Helicobacter pylori infection diagnosis during endoscopy” Journal of the Chinese Medical Association 81 (2018) 1033e1037 Chou CH, Sheu BS, Yang HB, Cheng PN, Shin JS, Chen CY, Lin XZ. Clinical assessment of the bacterial load of Helicobacter pylori on gastric mucosa by a new multi-scaled rapid urease test. J Gastroenterol Hepatol. 1997;12:1–6.

17. Resources https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGpGdmqfMJjkCNkGLGJckZlLHpg?projector=1&messagePartId=0.9 https://www.sciencedirect.com/science/article/pii/S2255534X16300354#:~:text=The%20patients%20with%20dyspepsia%20infected,58%25%20and%20increased%20with%20age https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785516/#B17 https://www.sciencedirect.com/science/article/pii/S2255534X16300354#:~:text=The%20patients%20with%20dyspepsia%20infected,58%25%20and%20increased%20with%20age . https://www.bli.eu/about-multi-light/about-bli/ https://link.springer.com/article/10.1007/s10620-010-1414-z

18. Assessment of Helicobacter pylori status by examination of gastric mucosal patterns: diagnostic accuracy of white-light endoscopy and narrow-band imaging https://www.fujifilm.com/sg/en/healthcare/endoscopy/endoscopy-processors/7000system https://journals.sagepub.com/doi/abs/10.1177/0194599816685701 https://www.ncbi.nlm.nih.gov/books/NBK557491/#:~:text=Sensitivity%20and%20specificity%20are%20inversely,a%20finding%20having%20no%20disease . https://healthcaresolutions-us.fujifilm.com/endoscopy/eluxeor-7000-system https://pubmed.ncbi.nlm.nih.gov/19413584/#:~:text=Measures%3A%20Sensitivity%20and%20specificity%20indicate,reported%20measures%20of%20test%20efficacy .