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What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus

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Abstract

We have reviewed articles on the longitudinal vessels observed in the lower esophagus. In our previous study, we observed longitudinal (palisading) vessels through the mucosal epithelium in 884 (98%) of 905 consecutive endoscopic examinations of the lower esophagus, whereas in 20 examinations (2%) they could not be observed because of inflammation. The lengths of the longitudinal vessels were within the range of 2 to 3 cm in 90% of investigations. “Indentation” (notch or narrowing) compatible with the esophageal hiatus was observed in the transitional zone between the tubal esophagus and saccular stomach by both radiographic (as an indentation) and endoscopic (as a narrowing; we used the term indentation in this article) examinations. In cases without hiatal hernia, the indentation coincided with the esophagogastric junction (EGJ). We examined endoscopically the relationships among the locations of the indentation, squamocolumnar junction, and the longitudinal vessels. In no patients did we observe longitudinal vessels through the gastric mucosa beyond the indentation. Therefore, observation of longitudinal vessels through the mucosal epithelium was an indicator that the mucosa was located within the esophagus. However, in 21% of the 884 observations, columnar-lined mucosa was seen continuously from the gastric mucosa proximally beyond the indentation, and longitudinal vessels were observed through this columnar-lined mucosa. Because the longitudinal vessels were peculiar to the esophageal mucosa, we could assume that this columnar-lined mucosa was located within the esophagus and was Barrett's mucosa, although very short. Therefore, Barrett's mucosa can be precisely diagnosed endoscopically by using the longitudinal vessels as diagnostic markers. The Japan Esophageal Society has authorized the endoscopic definition that the lower ends of the longitudinal vessels mark the limit of the EGJ.

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Authors and Affiliations

  1. Clinic of the Ministry of Economy, Trade and Industry, 1-3-1 Kasumigaseki, Chiyoda-ku, Tokyo, 100-8901, Japan

    Yoshio Hoshihara

  2. Center for Health Care and Public Concern, the Tokyo Kenbikyouin Foundation, Tokyo, Japan

    Takashi Kogure

Authors
  1. Yoshio Hoshihara
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  2. Takashi Kogure
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Correspondence to Yoshio Hoshihara.

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Hoshihara, Y., Kogure, T. What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus. Esophagus 3, 145–150 (2006). https://doi.org/10.1007/s10388-006-0096-2

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