The eradication rate of H. pylori varies depending on the treatment regimen, duration of therapy, and regional antibiotic susceptibility patterns. Although there are differences between countries, the efficacy of triple therapy has rapidly declined due to the increasing prevalence of antibiotic resistance [1,2]. A meta-analysis confirmed that the eradication success rates in Korea, which were 82.4% in intention-to-treat (ITT) analysis and 82.5% in per-protocol (PP) analysis in 2001, had decreased to 66.4% (ITT) and 76.4% (PP) by 2013 [3]. Consequently, susceptibility-guided tailored therapy has been proposed to overcome antibiotic resistance [4]. Antibiotic resistance varies across regions within the country, and the proportion of multidrug-resistant strains is also high. Tailored therapies are being explored, employing traditional culture-based susceptibility testing or simpler molecular diagnostic methods [5]. The success rates of eradication with these tailored therapies have been reported to be higher than those of conventional treatment, and interest in these therapies is growing as antibiotic resistance is expected to increase. Many studies have shown higher eradication success rates with tailored therapy than clarithromycin-based standard triple therapy [6-8]. Meta-analyses have further supported that tailored therapy is more effective than empirical therapy as first-line treatment (relative risk, 1.14 [95% confidence interval, 1.08–1.21]; I2=72.2%) without a significant difference in adverse event rates between the two treatments [9]. There is a clear clinical benefit to administering antibiotics with prior knowledge of susceptibility status. However, H. pylori is difficult to culture from gastric biopsy specimens due to its fastidious nature; precise conditions and expertise are required to successfully isolate this bacterium, making culture quite limited. Culturing is rarely feasible in hospitals or outpatient endoscopy centers, and gastric biopsy samples must be sent to commercial laboratories under strict transport conditions. Although research studies report 80%–90% success rates in culturing strains, U.S. clinical settings have reported culture success rates as low as 30% [10]. Adding to these difficulties is the limited number of laboratories dedicated to H. pylori culture, which are unevenly distributed around the world. Therefore, while bacterial culture remains a useful tool for monitoring first-line antibiotic resistance in epidemiological studies, its practical utility in routine clinical settings remains controversial. The constraints associated with the isolation and culture of H. pylori have led to concerns about the feasibility and reliability of this approach to guide individualized treatment in routine practice, and its widespread commercialization and application in first-line care is still in question. Guidelines from various regions around the world emphasize the importance of culture testing primarily after second-line treatment failure in clinical practice. However, there is still no consensus on the optimal timing for such testing [4,11,12]. When Hp-EuReg, a European non-interventional registry for the management of H. pylori infection, analyzed data from 21801 patients undergoing upper endoscopy up to December 2020, H. pylori cultures were performed in only 9.5%, or 3974 patients [13]. Antibiotic susceptibility registries that include regional data from across North America are still lacking, with cultures only recently being performed at a few major commercial laboratories [14]. Therefore technology that can accurately transport specimens to appropriate testing institutions can help overcome these limitations. According to past studies, appropriate temperature management and minimizing transport time are considered essential factors in increasing the success rate of H. pylori culture, and the transport condition of tissues seems to be particularly important in terms of temperature [15,16]. However, such studies are extremely rare, and there is little evidence to support the degree of clinical reliability of the results.