title: Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, jimmyso@nus.edu.sg.
authors.forename: Jimmy
authors.initials: J
authors.lastname: So
authors.forename: Andrea
authors.initials: A
authors.lastname: Rajnakova
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Amy
authors.initials: A
authors.lastname: Tay
authors.forename: Nilesh
authors.initials: N
authors.lastname: Shah
authors.forename: Manuel
authors.initials: M
authors.lastname: Salto-Tellez
authors.forename: Ming
authors.initials: M
authors.lastname: Teh
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Uedo
authors.initials: U
authors.lastname: Noriya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000175:diagnosis; D008875:Middle Aged; D062048:Narrow Band Imaging; D011230:Precancerous Conditions / Q000175:diagnosis*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis*