Mucosal Vascular Pattern Research Articles

The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus

A narrow band imaging (NBI) endoscopy system has been developed that allows superficial surface imaging of esophageal tissue in vivo. The objective was to assess the potential of NBI for prediction of histology during screening and surveillance endoscopy in patients with Barrett's esophagus (BE). A prospective cohort study. Veterans Affairs Medical Center. Fifty-one patients with known or suspected BE. NBI images were graded according to mucosal pattern (ridge/villous, circular and irregular/distorted) and vascular pattern (normal and abnormal), and correlated with histology in a prospective, blinded manner. Biopsy-confirmed intestinal metaplasia (IM) and dysplasia were used as the outcome measures. Of 51 patients (mean BE length 3.5 cm), 28 had IM without dysplasia, 8 had low-grade dysplasia (LGD), 7 had high-grade dysplasia (HGD), and 8 had cardiac-type mucosa. The sensitivity, specificity, and positive predictive value of ridge/villous pattern for diagnosis of IM without HGD were 93.5%, 86.7%, and 94.7%, respectively. The sensitivity, specificity, and positive predictive value of irregular/distorted pattern for HGD were 100%, 98.7%, and 95.3%, respectively. If biopsies were limited to areas with irregular/distorted pattern, no patient with HGD would have been missed. However, NBI was unable to distinguish areas of IM from those with LGD. The open study design without a control group was the main limitation. NBI is a novel diagnostic tool with a high degree of accuracy for the detection of metaplastic and dysplastic tissue within the BE segment.

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

STUDY OF THE TUMOR VESSELS IN DEPRESSED‐TYPE EARLY GASTRIC CANCERS USING NARROW BAND IMAGING MAGNIFYING ENDOSCOPY AND CDNA ARRAY ANALYSIS

Background: Since endoscopic mucosal resection has been applied to differentiated gastric cancers with invasion limited to the mucosal layer, the diagnosis of their differentiation is important. The degree of differentiation varies depending on the size and location of the tumors. Correct diagnosis by biopsy can be difficult because depressed‐type early gastric cancers sometimes contain mixed histology.Methods: Fifteen patients with depressed‐type early gastric cancers were observed by magnifying endoscopy with a narrow band lighting system. The fine mucosal vascular pattern was recorded and compared with the histological differentiation and features of vessels by staining with CD34. In some patients, cDNA array analysis was performed to determine differences among histological types.Results: Tumor vascular patterns were classified into two categories. Grid‐like network patterns not only characterized differentiated type but were also associated with high microvascular density. Short twig‐like patterns typified the undifferentiated type and a low vascular density. Differentiated types highly expressed some angiogenic factors, such as VEGFc and Flt‐4.Conclusions: Tumor vessel pattern of depressed‐type early gastric cancer obtained by narrow band imaging magnifying endoscopy reflects both the histological features and the degree of expression of angiogenic factors.

Superficial depressed type of poorly differentiated adenocarcinoma in the transverse colon

Endoscopic findings of the depressed type of poorly differentiated adenocarcinoma at an early stage have rarely been described. Herein is reported the endoscopic appearance of a typical case of depressed‐type carcinoma with poor differentiation in the transverse colon. The depressed‐type carcinoma, which had penetrated to the submucosa, was detected as a shallow depressed rough mucosa with interruption of the mucosal vascular pattern. The color of the lesion was almost the same as that of the surrounding non‐cancerous mucosa. Using the surface‐dyeing method, the lesion was demonstrated as a slightly depressed lesion with a well‐defined and irregular margin. With magnification, the surface of the lesion proved to have no pit structure. These endoscopic characteristics might be useful in detecting and evaluating the depressed type of poorly differentiated adenocarcinoma at an early stage.

THE ROLE OF ENDOSCOPY IN DIAGNOSIS OF LYMPHOPROLIFERATIVE DISORDER (LPD) IN THE GASTROINTESTINAL TRACT (GI) OF CHILDREN AFTER LIVER TRANSPLANTATION(LTx)

156 During the last 14 years 342 children underwent liver transplant (LTx) at UCLA Medical Center. Twenty nine patients (8.5%) developed lymphoproliferative disorder (LPD). Ten (34.5%) had gastrointestinal involvement. Eight had polyclonal and two monoclonal LPD. FK506 has been used in 9 patients: in 5 it was used as an initial immunosuppressive agent, 4 others were changed to it for chronic rejection after cyclosporine failed to prevent rejection. These 4 also received OKT3. The presenting GI symptoms of LPD were: GI bleeding (5), abdominal pain (5), diarrhea (5), vomiting and dehydration (2), mouth sores(1). All were associated with two or more weeks of fever. The earliest symptoms of LPD occurred two months post-LTx. All 10 had abdominal CT which was suggestive for GI involvement in 3 (27%). Upper and lower endoscopy was done in 7. In all the esophagus was normal. Gastric involvement was diagnosed in 3 children. Two had multiple deep ulcers throughout the stomach. Endoscopically the duodenum appeared normal in all 7. There were no false positives but one false negative endoscopic diagnosis. The proximal jejunum was examined in 2 children. Endoscopic findings were multiple erosions in one patient and white patches of mucosa in the other. Retrograde ileoscopy was performed in 3. All 3 had mucosal lesions: multiple ulcers (1), white patches (1) and erosions (1). Colonic involvement was diagnosed in 6: multiple ulcers (2), patchy erythema and thickening of the cecum (1) and loss of mucosal vascular pattern with spontaneous firability(3). Conclusion: Combined upper and lower endoscopy with the multiple biopsies is the best diagnostic approach for the evaluation of gastrointestinal involvement for LPD.

Microangiographic pattern in the small intestine of the cat after irradiation.

The microangiographic pattern in the experimentally irradiated small intestine of the cat was studied with two different techniques: infusion of Micropac and X-ray exposure on Kodak spectroscopic plates, and infusion of India ink and clearing the tissue as described by Spalteholtz. Bowels were irradiated with 10 to 30 Gy and examined from 4 days up to 4 months after irradiation. During the acute gastrointestinal radiation injury the mucosa was denuded and the microangiographic pattern strongly divergent from normal. After regeneration the vascular pattern depended on the dose given. After up to 15 Gy the vascular pattern looked quite normal even after 4 months. After higher doses and poor mucosal regeneration the vascular pattern did not return to normal. With 30 Gy no regeneration of the mucosal vascular pattern took place. Decreased vascularity was observed in all layers of the bowel. Variation in luminal width and obstruction of vessels were more frequent with higher doses.

Postmortem Demonstration of Esophageal Varices by a Simple Method

The usual methods available to demonstrate esophageal varices in postmortem material have met with little success because of their unreliability, difficulty to execute, or cost. A simple, inexpensive method, which consists in separating the esophageal mucosa and submucosa from the muscularis and stretching the former over a suitable absorbent paper, is described. In a few minutes, as the adherent membrane dries, the submucosal vascular pattern gradually develops, and after overnight drying, even the smallest venules are clearly visible. The specimen can be stored dry, photographed, or made into a more permanent preparation in a few days. The esophageal mucosal vascular patterns in groups of patients who died with a variety of hepatic diseases and other potential causes of esophageal varices were studied and compared with controls. A consistent pattern of prominent venous trunks located towards the distal third of the esophagus was seen in most specimens from cirrhotic patients, predominantly in micronodular forms with severe lobular distortion. Other potential causes of esophageal varices (hepatic tumors, congestion, etc.) resulted in less predictable vascular patterns.

The vascular architecture of the small intestinal mucosa of the monkey (Macaca mulatta).

AbstractSilicone rubber microvascular injection compounds have been used to describe the mucosal vascular architecture of the monkey's small intestine. The mucosal vascular patterns of this animal differ from the classical description. Instead of the villus blood supply being delivered via a central villus arteriole, the arterioles ramify to the undersurface of the mucosa where they terminate in the capillary plexus surrounding the crypts of Lieberkuhn. The villus capillary net is derived directly from the cryptic capillary plexus and is drained by a single, central villus vein. There is a secondary venous return system that directly drains the cryptic plexus. These secondary venous channels might represent a mechanism that regulates the proportional distribution of blood in the cryptic and villus capillary beds.This report is intended to describe the vascular patterns only as they occur in the monkey. Observations of rat and rabbit mucosa prepared by the same technique reveal arterial and venous channels extending the length of the villi. These animals, therefore, more closely resemble the classical description.