Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study

Background: A considerable number Of superficial gastric neoplasias are overlooked with conventional white light imaging (WLI) endoscopy. Objective: The aim was to investigate the diagnostic potential of trimodal imaging endoscopy (TME), which combines WLI, autofluorescence imaging (AFI), and narrow-band imaging (NBI), for superficial gastric neoplasia. Design: Feasibility study. Setting: Single academic center. Patients: Sixty-two patients with or without gastric neoplasia. Intervention: Each patient serially assessed with WLI, AFI, and magnifying endoscopy with NBI (ME-NBI) by an endoscopist blinded for clinical information. ME-NBI over WLI and AFI was designated as TME. Histopathology of biopsy and ESD specimens was evaluated and used as the gold standard. Main Outcome Measurements: Sensitivity and specificity of endoscopic diagnosis of pathology-proven neoplasia by per-patient and per lesion analyses. Results: The Study included 47 pathology-proven neoplasias and 44 pathology-proven nonneoplasias that were detected as neoplasias with any of the modalities. By a per-lesion analysis, the sensitivity of TME (89.4%) was higher than that of WLI (76.6%) and AFI (68.1%). The specificity of TME (98.0%) was higher than that of VU (84.3%) and AFI (23.5%). By a per-patient analysis, the sensitivity of TME (90.9%) was higher than that of WLI (75%) and AFI (68.2%). The specificity of TME (100%) was higher than that of WLI (72.2%) and AM (44.4%). Limitations: Case-enriched Population at a single center. Conclusions: Higher diagnostic accuracy of TME over conventional WLI indicates the feasibility of TME for the efficacious diagnosis of early gastric neoplasia. (Gastrointest Endosc 2009;70:899-906.)