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Abstract 14 We developed a novel multimodal video endoscope and evaluated its usefulness for the early detection of gastric neoplastic lesions. The imaging platform is a modified upper GI endoscope capable of white light imaging (WLI), widefield vital-dye fluorescence imaging (VFI) and high-resolution microendoscopy (HRME) in a single endoscopic insertion. A custom filter module is attached to the distal tip of the endoscope to enable VFI; HRME is performed by introducing a fiber optic probe through the endoscope working channel. Proflavine, a vital dye that stains nuclei is used to provide image contrast in both VFI and HRME. VFI images of proflavine stained tissue reveal the glandular patterns of the gastric mucosa, while HRME images reveal nuclear morphology with subcellular resolution. The performance of the platform was evaluated in a pilot study to image 35 patients with known or suspected gastric cancer undergoing either endoscopy or surgical resection. Patients were recruited at Mount Sinai Hospital, NY, and Hospital Evangelico in Siguatepeque, Honduras. For each patient, images were acquired with WLI, VFI and HRME sequentially during endoscopy. Images of neoplasia show disruption and effacement of glandular patterns. These alterations are visualized with enhanced contrast in VFI when compared to WLI; HRME images presenting the nuclear architecture at a subcellular level confirm these findings. Results suggest that this multimodal imaging platform can potentially enable a two-step protocol for early gastric cancer detection, wherein suspicious areas are red flagged with improved contrast using VFI, and then further imaged with HRME to confirm whether neoplasia is present based on changes in nuclear morphology. Given the convenient adaptation of the system design to other commercial endoscopes and the low cost of HRME (< $2,500), the utility of this multimodal imaging platform should be further evaluated in in vivo studies and low-resource settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Yubo Tang No relationship to disclose Jennifer Carns No relationship to disclose Timothy Quang No relationship to disclose Enrique M. Reina No relationship to disclose Susana Gonzalez No relationship to disclose Daniel G. Rosen Research Funding: Biotheragnostics Sharmila Anandasabapathy Honoraria: Medial Medical Rebecca R. Richards-Kortum Consulting or Advisory Role: Janssen Global Services Research Funding: Merck