Pre-endoscopy serological testing for XXXX : evaluation of a clinical decision tool.

@entity1 @entity66 @entity8265
OBJECTIVE: To determine an effective diagnostic method of detecting all cases of @entity66 in @entity1 referred for gastroscopy without performing routine duodenal biopsy. DESIGN: An initial retrospective cohort of @entity1 attending for gastroscopy was analysed to derive a clinical decision tool that could increase the detection of @entity66 without performing routine duodenal biopsy. The tool incorporated serology (measuring antibodies to @entity8265 ) and stratifying @entity1 according to their referral symptoms ( @entity1 were classified as having a "high risk" or "low risk" of @entity66 ). The decision tool was then tested on a second cohort of @entity1 attending for gastroscopy. In the second cohort all @entity1 had a routine duodenal biopsy and serology performed. SETTING: Teaching hospital in Sheffield. @entity1 : 2000 consecutive adult @entity1 referred for gastroscopy recruited prospectively. MAIN OUTCOME MEASURE: Evaluation of a clinical decision tool using @entity1 ' referral symptoms, @entity8265 antibody results, and duodenal biopsy results. RESULTS: No cases of @entity66 were missed by the pre-endoscopy testing algorithm. The prevalence of @entity66 in @entity1 attending for endoscopy was 3.9% (77/2000, 95% confidence interval 3.1% to 4.8%). The prevalence in the high risk and low risk groups was 9.6% (71/739, 7.7% to 12.0%) and 0.5% (6/1261, 0.2% to 1.0%). The prevalence of @entity66 in @entity1 who were negative for @entity8265 antibody was 0.4% (7/2000). The sensitivity, specificity, positive predictive value, and negative predictive value for a positive antibody result to diagnose @entity66 was 90.9%, 90.9%, 28.6%, and 99.6%, respectively. Evaluation of the clinical decision tool gave a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 60.8%, 9.3%, and 100%, respectively. CONCLUSIONS: Pre-endoscopy serological testing in combination with biopsy of high risk cases detected all cases of @entity66 . The use of this decision tool may enable the endoscopist to target @entity1 who need a duodenal biopsy.
