The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: an image analysis study.

The microvasculature of the lower oesophagus has been studied quantitatively using a computer assisted image analysis system. Twenty normal specimens of oesophagus and stomach were studied and seven further specimens from patients with varices were also assessed. Each specimen could be clearly subdivided into three zones. Zone 1 was the stomach where the mean relative area occupied by veins in the lamina propria was 2.6 per cent (s.e.m. +/- 0.2) in the normal subjects and 3.7 per cent (s.e.m. +/- 0.8) in the variceal specimens. Zone 2 began at the oesophagogastric junction and extended 2-5 cm into the lower oesophagus. The mean area occupied by veins in the lamina propria increased to 19.8 per cent (s.e.m. +/- 1.2) in the normal and 32.8 per cent (s.e.m. +/- 3.9) in the varices specimens. Zone 3 was the remainder of the proximal oesophagus and the mean area occupied by veins in the lamina propria was 4.9 per cent (s.e.m. +/- 0.3) in the normal and 6.1 per cent (s.e.m. +/- 0.5) in the varices specimens. Further analysis revealed that this increase in area occupied by veins in the distal oesophagus was due to an increase in both the number and size of vessels in the lamina propria of Zone 2. These findings may explain the propensity for oesophageal varices to bleed mainly from the distal oesophagus.