Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
Dig Dis Sci. 2013 Dec;58(12):3566-75. doi: 10.1007/s10620-013-2843-2. Epub 2013 Sep 1.
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.
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.
白光内镜（WLE）检测胃黏膜前病变和早期胃癌（EGC）通常较为困难。本研究旨在探讨联合应用自发荧光成像（AFI）和窄带成像（NBI）是否能提高高危人群胃黏膜前病变和早期胃癌的检出率。
采用前瞻性、随机交叉设计，由两位经验丰富的内镜医师连续对 65 例 50 岁以上消化不良的中国患者行高分辨率 WLE 及 AFI 联合 NBI 检查。主要终点为两种方法对肠化生（IM）和黏膜萎缩等前病变患者的诊断能力。
共纳入 65 例患者，1 例进展期胃癌患者被发现并排除。在其余 64 例患者中，38 例（59%）存在 IM，其中 26 例（68%）经 AFI-NBI 正确识别（敏感性 68%，特异性 23%），而仅 13 例（34%）经 WLE 识别（敏感性 34%，特异性 65%）。与 WLE 相比，AFI-NBI 检测出更多的 IM 患者（p=0.011）。31 例（48%）存在黏膜萎缩，其中 10 例（32%）经 AFI-NBI 识别（敏感性 32%，特异性 79%），4 例（13%）经 WLE 识别（敏感性 13%，特异性 88%）（p=0.100）。未发现异型增生或 EGC。
与 WLE 相比，AFI-NBI 能更准确地识别 IM 患者。本研究结果提示，AFI-NBI 联合内镜检查可能有助于发现胃黏膜前病变。
