title: Detection of palisade vessels as a landmark for Barrett's esophagus in a Western population.
abstract: BACKGROUND
  In Japan, palisade vessels (PV) are used to distinguish the esophagogastric junction (EGJ). Elsewhere, the EGJ is defined by the upper end of the gastric folds (GF) and PV are considered difficult to detect. This study evaluated the detection rate of PV in Western patients with Barrett's esophagus (BE) using white light imaging (WLI) and narrow band imaging (NBI), and quantified any discordance between Western and Japanese criteria for the EGJ.
  
  
  METHODS
  In 25 BE patients, the presence and location of PV and GF were determined and biopsies were obtained. High-quality images of the EGJ were collected under different conditions (insufflations-desufflation, WLI-NBI, forward-retroflex approach), resulting in eight different images per patient. The presence of PV on each still image was assessed by a panel of six Western and Japanese endoscopists with expertise in BE.
  
  
  RESULTS
  PV were observed in ≥ 1 images by a majority of the panel (≥ 4 raters) in 100 % of patients during insufflation versus 60 % during desufflation (p < 0.001). WLI and NBI detected PV in 100 and 92 %, respectively (p = 0.50). Interobserver agreement of the panel was 'moderate' (κ = 0.51). During endoscopy PV were located a median of 1 cm distal of the GF in 15 patients (63 %), with intestinal metaplasia (IM) in this discordant zone, in 27 % of patients.
  
  
  CONCLUSIONS
  PV are visible in most Western BE patients and are best inspected during insufflation. The location of the GF and PV differed in a substantial group of patients, partially with IM in this discordant zone.
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands. d.scholvink@antoniusziekenhuis.nl.|Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. d.scholvink@antoniusziekenhuis.nl.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Schölvinck
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.affiliation: Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Cornelis A
authors.initials: CA
authors.lastname: Seldenrijk
authors.affiliation: Department of Gastroenterology, University Hospital Leuven, Louvain, Belgium.
authors.forename: Raf
authors.initials: R
authors.lastname: Bisschops
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ochiai
authors.affiliation: Department of Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.affiliation: Department of Gastroenterology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Boudewijn E
authors.initials: BE
authors.lastname: Schenk
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.|Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
mesh_terms: D000368:Aged; D044466:Asian People; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000473:pathology; D004724:Endoscopy; D004943:Esophagogastric Junction / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008679:Metaplasia / Q000000981:diagnostic imaging; D008875:Middle Aged; D062048:Narrow Band Imaging; D009426:Netherlands; D011446:Prospective Studies; D044465:White People
keywords: Barrett’s esophagus; Esophagogastric junction; Gastric folds; Palisade vessels