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Title: Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore
Authors: So, J.
Rajnakova, A.
Chan, Y.-H.
Tay, A.
Shah, N.
Salto-Tellez, M. 
Teh, M.
Noriya, U.
Keywords: Autofluorescence imaging
Gastric atrophy
Gastric cancer
Intestinal metaplasia
Narrow-band imaging
Issue Date: Dec-2013
Citation: So, J., Rajnakova, A., Chan, Y.-H., Tay, A., Shah, N., Salto-Tellez, M., Teh, M., Noriya, U. (2013-12). Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore. Digestive Diseases and Sciences 58 (12) : 3566-3575. ScholarBank@NUS Repository.
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. 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. © 2013 Springer Science+Business Media New York.
Source Title: Digestive Diseases and Sciences
ISSN: 01632116
DOI: 10.1007/s10620-013-2843-2
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