Yoshida N, Doyama H, Yano T, et al. - Given that early detection of gastric cancer was the topic of major efforts in high prevalence areas, researchers conducted this open-label, randomised, controlled tandem trial to ascertain if advanced imaging methods like second-generation narrow band imaging (2G-NBI) can improve early detection. This investigation was performed in 13 hospitals. For this analysis, individuals at increased risk for gastric cancer were randomly assigned to primary white light imaging (WLI) followed by secondary 2G-NBI (WLI group: n = 2,258) and primary 2G-NBI followed by secondary WLI (2G-NBI group: n = 2,265) performed by the same examiner. Positive predictive value (PPV) for early gastric cancer (EGC) in suspicious lesions, respectively, was 13.5% and 20.9% in the WLI and 2G-NBI groups. Primary endoscopy's overall sensitivity to detect EGC in high-risk patients was just 75% and could be enhanced. 2G-NBI did not increase the detection rate for EGC over conventional WLI. The impact of a slightly better PPV of 2G-NBI must be further assessed.