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Purpose: To evaluate the diagnostic values of autofluorescence imaging (AFI) combined with narrow band imaging (NBI) in diagnosing early gastric cancer and precancerous lesions., Methods: 140 patients were investigated for lesions such as gastric mucosal roughness, erosion, plaque, abnormal color, bump or pitting by conventional endoscopy. AFI endoscope was used for the observation, and the endoscopic diagnosis was performed according to the fluorescence forms under the endoscopic AFI mode, as well as the changes of gastric mucosal capillaries and gastric pits under the NBI mode. The corresponding lesions were also biopsied for pathological examination., Results: 78 patients were diagnosed as gastritis (including superficial and atrophic gastritis), 45 as intestinal metaplasia, 6 as dysplasia, and 11 as early gastric cancer. The sensitivity and specificity of AFI-NBI combination were 88.89 and 91.58% in the diagnosis of intestinal metaplasia; 83.33 and 98.51% for dysplasia; and 90.91 and 99.22% for early gastric cancer. All of them were significantly higher than the simple fluorescence endoscopy., Conclusions: The AFI-NBI combination could improve the detection rate of early gastric cancer and precancerous lesions.