Efficacy of autofluorescence imaging for flat neoplasm detection: a multicenter randomized controlled trial (A-FLAT trial)

Yoji Takeuchi, Manabu Sawaya, Shiro Oka, Naoto Tamai, Takuji Kawamura, Toshio Uraoka, Hiroaki Ikematsu, Tomohiko Moriyama, Masamichi Arao, Hideki Ishikawa, Yuri Ito, Takahisa Matsuda

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16 Citations (Scopus)


Background and Aims: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. Methods: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. Results: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients’ backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI],.78-.97] vs.53 [95% CI,.46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24],.46 [95% CI,.40-.53] vs.60 [95% CI,.53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI,.54-.70] vs.30 [95% CI,.25-.36]) but not in the left-sided colon and rectum (.26 [95% CI,.21-.32] vs.23 [95% CI,.19-.28]). Conclusions: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.)

Original languageEnglish
Pages (from-to)460-469
Number of pages10
JournalGastrointestinal endoscopy
Issue number3
Publication statusPublished - Mar 2019

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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