Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore

Jimmy So, Andrea Rajnakova, Yiong-Huak Chan, Amy Tay, Nilesh Shah, Manuel Salto-Tellez, Ming Teh, Noriya Uedo, Uedo Noriya

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)3566-75
Number of pages10
JournalDigestive Diseases and Sciences
Issue number12
Publication statusPublished - Dec 2013


  • Aged
  • Aged, 80 and over
  • Atrophy
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Gastric Mucosa
  • Gastroscopy
  • Humans
  • Male
  • Metaplasia
  • Middle Aged
  • Narrow Band Imaging
  • Precancerous Conditions
  • Prospective Studies
  • Stomach Neoplasms


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