Digestive Diseases and Sciences

, Volume 58, Issue 12, pp 3566–3575 | Cite as

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

  • Jimmy SoEmail author
  • Andrea Rajnakova
  • Yiong-Huak Chan
  • Amy Tay
  • Nilesh Shah
  • Manuel Salto-Tellez
  • Ming Teh
  • Uedo Noriya
Original Article



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.


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.


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.


Autofluorescence imaging Narrow-band imaging Endoscopy Intestinal metaplasia Gastric atrophy Gastric cancer 


Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jimmy So
    • 1
    Email author
  • Andrea Rajnakova
    • 2
  • Yiong-Huak Chan
    • 3
  • Amy Tay
    • 1
  • Nilesh Shah
    • 4
  • Manuel Salto-Tellez
    • 5
  • Ming Teh
    • 5
  • Uedo Noriya
    • 6
  1. 1.Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Department of Gastroenterology and HepatologyNational University HospitalSingaporeSingapore
  3. 3.Biostatistics Unit, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  4. 4.Oncology Research Institute, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  5. 5.Department of Pathology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  6. 6.Department of Gastrointestinal OncologyOsaka Medical Centre for Cancer and Cardiovascular DiseaseOsakaJapan

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