Endoscopic Tri-Modal Imaging Improves Detection of Gastric Intestinal Metaplasia Among a High-Risk Patient Population in Singapore

Background Detection of pre-neoplastic gastric mucosal changes and early gastric cancer (EGC) by white-light endoscopy (WLE) is often difficult. In this study we investigated whether combined autofluorescence imaging (AFI) and narrow band imaging (NBI) can improve detection of pre-neoplastic lesions and early gastric cancer in high-risk patients. Patients and Methods Chinese patients who were 50-years-old or above with dyspepsia were examined by both high-resolution WLE and combined AFI followed by NBI (AFI–NBI), consecutively in a prospective randomized cross-over setting, by two experienced endoscopists. The primary outcome was diagnostic ability of the two methods for patients with pre-neoplastic lesions such as intestinal metaplasia (IM) and mucosal atrophy. Results Sixty-five patients were recruited. One patient with large advanced gastric cancer was found and excluded from the analysis. Among the remaining 64 patients, 38 (59 %) had IM; of these, 26 (68 %) were correctly identified by AFI–NBI (sensitivity 68 %, specificity 23 %) and only 13 (34 %) by WLE (sensitivity 34 %, specificity 65 %). AFI–NBI detected more patients with IM than did WLE ( p = 0.011). Thirty-one patients (48 %) had mucosal atrophy. Ten patients (32 %) were identified by AFI–NBI (sensitivity 32 %, specificity 79 %) and four patients (13 %) by WLE (sensitivity 13 %, specificity 88 %) ( p = 0.100). No dysplasia or EGC was found. Conclusion AFI–NBI identified significantly more patients with IM than did WLE. Our result warrants further studies to define the role of combined AFI–NBI endoscopy for detection of precancerous conditions.