title: Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy.
abstract: BACKGROUND
  In patients with portal hypertension, EUS reveals the presence of collateral vessels within and outside the esophageal wall such as esophageal varices, periesophageal collateral veins (peri-ECVs), paraesophageal collateral veins (para-ECVs), and perforating veins. This study retrospectively compared radial EUS images of these collateral vessels with histopathologic findings.
  
  
  METHODS
  Four patients with esophageal varices treated by endoscopic injection sclerotherapy were studied. EUS was performed to evaluate the effects of endoscopic injection sclerotherapy. After endoscopic injection sclerotherapy, the segment of the esophagus from the esophagogastric junction to a point 5 cm proximal to junction was imaged with a 20-MHz radial scanning catheter US probe. Esophageal collateral veins outside the esophageal wall were identified as peri-ECVs (veins lateral to muscularis propria or within adventitia) and para-ECVs (veins lateral and separate from muscularis propria) along with perforating veins (veins connecting extramural collateral veins to submucosal varices). At autopsy, the esophagus with surrounding tissue was removed and cross-sectioned at 1-cm intervals from the esophagogastric junction to a point 5 cm proximal to the junction. Radial EUS images were correlated with histopathologic findings.
  
  
  RESULTS
  Radial EUS after endoscopic injection sclerotherapy demonstrated peri-ECVs and perforating veins in all cases and para-ECVs in 3 cases. Based on histopathologic findings, veins associated with the esophageal wall were divided into 3 groups: those adjacent to the muscularis propria, veins separated from the wall without contact with the muscularis propria, and veins perforating the muscularis propria. All 3 groups of veins were observed in all cases. These 3 types of veins identified by histopathologic examination corresponded, respectively, to the peri-ECVs, para-ECVs, and perforating veins observed by EUS.
  
  
  CONCLUSIONS
  Collateral esophageal veins demonstrated by radial EUS in patients with portal hypertension correspond to collateral veins identified histopathologically. In patients with portal hypertension, EUS is useful for assessment of vascular anatomy around the esophageal wall.
authors.affiliation: Department of Internal Medicine 2, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
authors.forename: Ayako
authors.initials: A
authors.lastname: Saito
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Hideo
authors.initials: H
authors.lastname: Shishido
authors.forename: Hajime
authors.initials: H
authors.lastname: Odajima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Abe
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugino
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Reiji
authors.initials: R
authors.lastname: Kasukawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sato
mesh_terms: D000368:Aged; D001344:Autopsy; D003097:Collateral Circulation; D019160:Endosonography; D004947:Esophagus / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D012189:Retrospective Studies