Endoscopically observed lower esophageal capillary patterns.

Area of Science:

• Gastroenterology
• Endoscopic diagnostics
• Anatomical variations

Background:

• Four distinct venous patterns exist around the gastroesophageal junction (GEJ): truncal, perforating, palisade zone (PZ), and gastric.
• The distal end of the PZ serves as a potential endoscopic landmark for the GEJ.
• Prevalence of endoscopic Barrett's esophagus (E-BE) and endoscopic hiatal hernia (E-HH) requires further investigation in specific populations.

Purpose of the Study:

• To evaluate the length and patterns of the palisade zone (PZ) in a Korean population.
• To determine the prevalence of endoscopic Barrett's esophagus (E-BE) and endoscopic hiatal hernia (E-HH) using PZ as a GEJ marker.
• To analyze the relationship between PZ patterns and the occurrence of E-BE and E-HH.

Main Methods:

• A total of 847 consecutive patients undergoing diagnostic endoscopy were included.
• Endoscopic identification and classification of palisade zone (PZ), squamocolumnar junction (SCJ), and pinchcock action (PCA) were performed.
• Patterns were categorized based on the relative positions of PZ, SCJ, and PCA; E-BE was associated with patterns B and D, while E-HH was linked to patterns C and D.

Main Results:

• The observed frequencies for PZ patterns A, B, C, and D were 79.2%, 12.1%, 3.8%, and 4.9%, respectively.
• The average length of the PZ was measured at 3.0 ± 0.1 cm.
• The prevalence of E-BE was 17.0% and E-HH was 8.7%; both were more common in males and patients with reflux esophagitis.

Conclusions:

• Endoscopic Barrett's esophagus (E-BE) and endoscopic hiatal hernia (E-HH) are more prevalent in Koreans than previously assumed.
• Utilizing the distal end of the palisade zone (PZ) as an endoscopic marker for the gastroesophageal junction (GEJ) aids in identifying these conditions.
• The findings underscore the importance of recognizing specific PZ patterns for diagnosing E-BE and E-HH in the Korean population.