Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2016; 8(19): 690-696
Published online Nov 16, 2016. doi: 10.4253/wjge.v8.i19.690
Microvasculature of the esophagus and gastroesophageal junction: Lesson learned from submucosal endoscopy
Roberta Maselli, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Esperanza Grace Santi, Hiroki Sato, Bu’Hussain Hayee, Shin-Ei Kudo
Roberta Maselli, Haruhiro Inoue, Haruo Ikeda, Manabu Onimaru, Akira Yoshida, Esperanza Grace Santi, Hiroki Sato, Bu’Hussain Hayee, Shin-Ei Kudo, Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan
Roberta Maselli, Department of “Paride Stefanini” Surgical, Umberto I° General Hospital, Sapienza University of Rome, 00161 Rome, Italy
Bu’Hussain Hayee, King's College Hospital NHSFT, London WC2R 2LS, United Kingdom
Author contributions: Maselli R and Inoue H contributed to conception and design; Maselli R contributed to drafting of the article; Ikeda H, Onimaru M, Yoshida A and Sato H contributed to data collection, analysis and interpretation of the data; Santi EG contributed to analysis and interpretation of the data; Hayee B contributed to clinical revision; Kudo S contributed to clinical revision and final approval.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Roberta Maselli, MD, Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama 224-8503, Japan.
Telephone: +81-45-9497000
Received: April 28, 2015
Peer-review started: May 5, 2015
First decision: October 26, 2015
Revised: October 10, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 16, 2016

Advanced therapeutic endoscopy, in particular endoscopic mucosal resection, endoscopic submucosal dissection, per-oral endoscopic myotomy, submucosal endoscopic tumor resection opened a new era where direct esophageal visualization is possible. Combining these information with advanced diagnostic endoscopy, the esophagus is organized, from the luminal side to outside, into five layers (epithelium, lamina propria with lamina muscularis mucosa, submucosa, muscle layer, adventitia). A specific vascular system belonging to each layer is thus visible: Mucosa with the intra papillary capillary loop in the epithelium and the sub-epithelial capillary network in the lamina propria and, at the lower esophageal sphincter (LES) level with the palisade vessels; submucosa with the drainage vessels and the spindle veins at LES level; muscle layer with the perforating vessels; peri-esophageal veins in adventitia. These structures are particularly important to define endoscopic landmark for the gastro-esophageal junction, helpful in performing submucosal therapeutic endoscopy.

Keywords: Microvasculature, Esophageal anatomy, Submucosal endoscopy, Per-oral endoscopic myotomy, Advanced imaging

Core tip: In the last years advanced endoscopic technology and techniques allowed the possibility to in vivo evaluate the esophageal vasculature. We aimed to review the endoscopic endoluminal and transluminal appearance of the esophageal vascular structures. This paper will allow the reader to deeply understand mucosal, submucosal and muscular layer vessels by a direct endoscopic visualization. The authors’ knowledge of the characteristic changes in health and disease, as well as descriptions of anatomical landmarks, will serve to inform the practice of endoscopic surgery in the future.