The patient experience and clinical efficacy of a novel virtual c13ubt service at an irish tertiary referral center during the covid 19 pandemic

Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.