Tahahiro Sato1, Yo Kato. 1. Gastrointestinal Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center, Hidaka, Japan.
Abstract
BACKGROUND/AIMS: Endoscopically, as a marker of the EGJ (Esophago-gastric Junction), the most distal end of the palisading longitudinal esophagus vessels (PLEVs) is useful. The aim of this study is to clarify the origin of PLEVs. METHODOLOGY: The present study included 10 patients who underwent esophagectomy and proximal gastrectomy. Vascular injection of radiopaque medium was performed for fresh resected specimens. Subsequently, specimens were opened longitudinally, pinned on a corkboard, and fixed overnight in 4% buffered formaldehyde. Injected vessels were simultaneously examined macroscopically, radiographically, and histopathologically. The injection medium consisted of liquid barium (providing radiopacity), 3% agarose gel (1g/100 mL H2O, providing stability) and carmin (providing macroscopical visibility with red color). Five cases were performed via veins and the other 5 cases via arteries. RESULTS: All vein-injected and longitudinally-opened specimens showed PLEVs around EGJ. Red color stained thin vessels were superficially recognized at almost the same density of vascularity as radiopraphically examined vessels. Macroscopic and radiographic images were easily superimposed concoding PLEVs and EGJ. On the other hand, there are no cases demonstrating PLEVs by artery-injected images. Histopathologically, PLEVs were apparent in the lamina propria mucosae just above muscularis mucosae. PLEVs penetrate obliquely from oral to distal in the submucosa at EGJ. PLEVs were positive for CD31 but negative for D2-40. CONCLUSIONS: PLEVs are the stream of superficial veins, not arteries.
BACKGROUND/AIMS: Endoscopically, as a marker of the EGJ (Esophago-gastric Junction), the most distal end of the palisading longitudinal esophagus vessels (PLEVs) is useful. The aim of this study is to clarify the origin of PLEVs. METHODOLOGY: The present study included 10 patients who underwent esophagectomy and proximal gastrectomy. Vascular injection of radiopaque medium was performed for fresh resected specimens. Subsequently, specimens were opened longitudinally, pinned on a corkboard, and fixed overnight in 4% buffered formaldehyde. Injected vessels were simultaneously examined macroscopically, radiographically, and histopathologically. The injection medium consisted of liquid barium (providing radiopacity), 3% agarose gel (1g/100 mL H2O, providing stability) and carmin (providing macroscopical visibility with red color). Five cases were performed via veins and the other 5 cases via arteries. RESULTS: All vein-injected and longitudinally-opened specimens showed PLEVs around EGJ. Red color stained thin vessels were superficially recognized at almost the same density of vascularity as radiopraphically examined vessels. Macroscopic and radiographic images were easily superimposed concoding PLEVs and EGJ. On the other hand, there are no cases demonstrating PLEVs by artery-injected images. Histopathologically, PLEVs were apparent in the lamina propria mucosae just above muscularis mucosae. PLEVs penetrate obliquely from oral to distal in the submucosa at EGJ. PLEVs were positive for CD31 but negative for D2-40. CONCLUSIONS: PLEVs are the stream of superficial veins, not arteries.