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Lung cancer tends to be detected at an advanced stage, resulting in a high patient mortality rate. Thus, much recent research has focused on early disease detection Bronchoscopy is the procedure of choice for an effective noninvasive way of detecting early manifestations (bronchial lesions) of lung cancer. In particular, autofluorescence bronchoscopy (AFB) discriminates the autofluorescence properties of normal (green) and diseased tissue (reddish brown) with different colors. Because recent studies show AFB's high sensitivity in searching lesions, it has become a potentially pivotal method in bronchoscopic airway exams. Unfortunately, manual inspection of AFB video is extremely tedious and error prone, while limited effort has been expended toward potentially more robust automatic AFB lesion analysis. We propose a real-time (processing throughput of 27 frames/sec) deep-learning architecture dubbed ESFPNet for accurate segmentation and robust detection of bronchial lesions in AFB video streams. The architecture features an encoder structure that exploits pretrained Mix Transformer (MiT) encoders and an efficient stage-wise feature pyramid (ESFP) decoder structure. Segmentation results from the AFB airway-exam videos of 20 lung cancer patients indicate that our approach gives a mean Dice index = 0.756 and an average Intersection of Union = 0.624, results that are superior to those generated by other recent architectures. Thus, ESFPNet gives the physician a potential tool for confident real-time lesion segmentation and detection during a live bronchoscopic airway exam. Moreover, our model shows promising potential applicability to other domains, as evidenced by its state-of-the-art (SOTA) performance on the CVC-ClinicDB, ETIS-LaribPolypDB datasets, and superior performance on the Kvasir, CVC-ColonDB datasets.