Magnification Endoscopic and Histologic Observations of Palisade Vessels at the Esophagogastric Junction, with Reference to Their Nature and Histologic Utility
Junko Aida, Yoko Tateishi, Michael Vieth, Youichi Kumagai, Tomio Arai, Motoji Sawabe, Mutsunori Fujiwara, Tsunekazu Hishima, Ken-ichi Nakamura, Naotaka Shimomura, Naoshi Ishikawa, Kaiyo Takubo. Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan; Klinikum Bayreuth, Bayreuth, Germany; Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Japanese Red Cross Medical Center, Tokyo, Japan
Background: Endoscopy is able to demonstrate palisade vessels at the level of the lower esophageal sphincter, but they are not present in the middle esophagus and stomach. We examined these vessels both endoscopically and histologically, clarified their density and caliber, and assessed their histologic utility for distinguishing samples of Barrett's esophagus (BE) from those of gastric cardia.
Design: We examined the density and caliber of palisade vessels by magnifying endoscopy with narrow-band imaging in 15 consecutive patients without GERD or BE, and histologically examined the incidence of veins >100 μm in diameter defined as palisade vessels in the middle and lower esophagus and stomach in 20 autopsy cases, and also in endoscopic mucosal resection (EMR) specimens from the gastric cardia (20 cases) and BE (66 cases). In the EMR specimens, we also examined 3 histologic markers of esophageal tissue: esophageal glands, squamous islands, double muscularis mucosae.
Results: Endoscopically, palisade vessels were not observed in the stomach and middle esophagus. The density of palisade vessels was highest near the squamocolumnar junction (SCJ), and gradually became more confluent and showed an increase in thickness towards their upper limit. The palisade vessels were 75 – 275 μm in diameter. Palisade vessels were evident histologically only in the mucosa of the lower esophagus in the autopsy cases, and were not observed in the gastric EMR specimens. However, 71% of the BE EMR specimens contained them. The 3 markers were not evident in the stomach EMR specimens, but present in 33%, 18%, and 71% of the BE EMR specimens, respectively.
Conclusions: We demonstrated that blood in palisade vessels flows orad from the SCJ, and that palisade vessels are a distinctive feature of esophageal tissue, in addition to the 3 markers already recognized.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 57, Tuesday Afternoon