Stomach and Intestine(Tokyo) Volume 51, Issue 5 (May 2016)
Japanese

Vascular Networks of the Normal Esophageal Mucosa Seen Using Magnifying Endoscopy with Narrow Band Imaging Kumiko Momma 1 , Junko Fujiwara 1 , Yoko Tateishi 2 , Shin-ichiro Horiguchi 3 , Tsunekazu Hishima 3 , Kunihito Suzuki 4 , Akinori Miura 4 , Tsuyoshi Katoh 4 , Youichi Kumagai 5 , Misao Yoshida 6 1Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan 3Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan 6Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 拡大内視鏡 , NBI(narrow band imaging) , 正常像 , IPCL(intraepithelial papillary capillary loop) pp.535-543
Published Date 2016/5/24
DOI https://doi.org/10.11477/mf.1403200612
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 Recent advances in magnifying endoscopy assisted by NBI(narrow band imaging)have enabled us to study the vascular system of the esophageal mucosa in great detail. Abnormalities in the number, size, shape, and distribution of small vessels in the mucosa yield important information in terms of pathological changes. In the present paper, we provide an overview of blood vessel structures in the normal esophageal mucosa seen using magnifying endoscopy and NBI.

 Magnifying endoscopy and NBI revealed two small vascular networks in different mucosal layers, which communicate with each other and create a stratified vascular network. There are vascular networks in the lower part of the lamina propria(LPM)and in the upper part of the LPM close to the squamous epithelium. NBI observation revealed that blood vessels of the vascular networks in the LPM are composed of small vessels exhibiting differences in size, shape, and color. Vessels in the lower LPM networks are larger in size than those in the upper LPM and they can be recognized by NBI as brown-colored vessels. Vascular networks in the lower LPM can also be recognized by conventional endoscopy as a reticular vascular network in the esophageal mucosa and as palisade vessels at the pharyngoesophageal and esophagogastric junctions. These structures are recognized by NBI as brown-colored blood vessels. The size of the network vessels in the lower LPM lies between those of SM and capillary vessels. Vesssels in SM are recognized as green vessels in NBI observation and larger in size than those of LPM vessels. Palisade vessels are dense in the lower esophagus while they are narrow and coarse in the esophageal orifice. Endoscopically, the esophagogastric junction can be identified as a lower margin of palisade vessels. Palisade vessels in the lower pharynx are frequently connected to palisade vessels in the upper esophagus, making endoscopic identification of the pharyngoesophageal junction difficult via the simple observation of mucosal vessels. Capillary vessels branch off from the lower LPM vascular network, creating capillary vascular networks close to the squamous epithelium(sub-epithelial capillary network ; SCN). Finally, capillary vessels branch off from SCN and enter into LPM of the epithelial papilla in the esophageal mucosa. These vessels then return to SCN or lower LPM network, thus, creating a capillary loop(intra-epithelial papillary capillary loop). The pharyngeal mucosa is also covered by stratified squamous epithelium, which has almost the same vascular structure as that of the esophageal mucosa.


Copyright © 2016, Igaku-Shoin Ltd. All rights reserved.

基本情報

05362180.51.5.jpg
胃と腸
51巻5号 (2016年5月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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