title: Microvasculature of the esophagus and gastroesophageal junction: Lesson learned from submucosal endoscopy.
abstract: 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.
authors.affiliation: 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.
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.affiliation: 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.
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: 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.
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: 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.
authors.forename: Manabu
authors.initials: M
authors.lastname: Onimaru
authors.affiliation: 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.
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: 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.
authors.forename: Esperanza Grace
authors.initials: EG
authors.lastname: Santi
authors.affiliation: 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.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sato
authors.affiliation: 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.
authors.forename: Bu'Hussain
authors.initials: B
authors.lastname: Hayee
authors.affiliation: 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.
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
keywords: Advanced imaging; Esophageal anatomy; Microvasculature; Per-oral endoscopic myotomy; Submucosal endoscopy