Autofluorescence endoscopy versus conventional white light endoscopy for the detection of superficial gastric neoplasia: A prospective comparative study

Background and study aims: Preliminary studies have suggested autofluorescence endoscopy (AFE) to be accurate in the diagnosis of gastric tumors. Our prospective blinded study systematically compared AFE with white light endoscopy (WLE) for the detection of superficial gastric neoplasia. Patients and methods: An enriched population included 33 patients with superficial gastric neoplasia referred for endoscopic submucosal dissection (ESD), and 18 control patients undergoing follow-up endoscopy after curative ESD. At the direction of a study coordinator, two endoscopists who were blinded to the patient's history and to each other's findings, performed WLE followed by AFE or performed AFE alone, in random order. Both endoscopists independently recorded the presence of lesions seen at AFE and WLE. All lesions identified in either test were biopsied and the pathological results were used as the gold standard. Results: 39 gastric neoplasias were histologically confirmed and 52 non-neoplastic lesions were found to be either WLE- and/or AFE-positive. Sensitivities of WLE and AFE alone were 74% vs. 64% (n.s.) and specificities were 83% vs. 40% (P = 0.0003), respectively. WLE followed by AFE had a sensitivity of 69 % (n. s.) and a specificity of 64 % (P = 0.046 compared with WLE alone). Of all neoplasias finally diagnosed, 13 % (or in the case of elevated neoplasias, 23%) were detected by AFE but not by WLE. Conclusions: Although one quarter of elevated gastric neoplasias were detected only by AFE, its specificity is poor; therefore its clinical value is limited.