Gastric microvascular architecture as visualized by magnifying endoscopy: body and antral mucosa without pathologic change demonstrate two different patterns of microvascular architecture

To the Editor:I read with great interest the article by Nakagawa et al.1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar on the usefulness of magnifying endoscopy for the diagnosis of Helicobacter pylori–induced histopathologic gastritis. They classified the morphologic characteristics of the collecting venula (CV) as visualized by magnification into 3 patterns; regular (R), irregular, and obscure. The cases with the R pattern CV were negative for H pylori infection at all sites observed with a magnifying endoscope. Therefore, the R pattern is a good predictor for H pylori-negative status. I consider that these results are indeed reliable and provide a more objective method for predicting the absence of H pylori infection than non-magnified endoscopic observation alone.However, further discussion is needed regarding certain results in the study of Nakagawa et al.1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar The sensitivity of the R pattern for negative H pylori status differed between the gastric antrum and body. In the antral mucosa, the sensitivity was low (30.6%), whereas, it was high (63.9%-66.7%) in the gastric body. This difference in sensitivity could originate simply from differences in the normal microvascular architecture of the stomach. As reported with regard to histopathologic findings2.Gannon B. The vasculature and lymphatic drainage.in: Whitehead R. Gastrointestinal and oesophageal pathology. Churchill Livingstone, Edinburgh1995: 129-199Google Scholar and magnified observations,3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar there are two distinctly different patterns of mucosal microvascular architecture between the gastric antrum and body as visualized by magnifying endoscopy. In the body mucosa without pathologic change, magnifying endoscopy demonstrates a honeycomb-shaped subepithelial capillary network pattern surrounding gastric pits, and this pattern is constantly accompanied by CV in a regular arrangement.3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar, 4.Yagi K. Nakamura A. Seike A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection.J Gastroenterol Hepatol. 2002; 17: 39-45Crossref PubMed Scopus (138) Google Scholar However, in the antral mucosa, a coil-shaped subepithelial capillary network pattern is observed in relatively elevated apical parts between the antral gastric sulci and pits, but this pattern is rarely accompanied by CVs.3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google ScholarIt has been suggested that because the CVs of the antral mucosa are located at a relatively deeper site from the surface epithelium compared with those of the body mucosa,2.Gannon B. The vasculature and lymphatic drainage.in: Whitehead R. Gastrointestinal and oesophageal pathology. Churchill Livingstone, Edinburgh1995: 129-199Google Scholar, 3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar the CV cannot be observed optically, even in H pylori–negative gastric antral mucosa. These basic anatomical characteristics should be taken into consideration when interpreting the magnifying endoscopic findings of the mucosal microvasculature. Accordingly, the low sensitivity of the R pattern in antral mucosa without H pylori infection, as observed in the study of Nakagawa et al.,1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar is simply because of the normal anatomical arrangement, which accounts for the low frequency of visualization of CV in the antral mucosa itself.The results of Nakagawa et al.,1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar on the other hand, do provide an additional important fact; to date, there has been no study reported that verifies the frequency of collecting venulae in the antral mucosa without H pylori infection as visualized by magnifying endoscopy. The sensitivity (30.6%) of the R pattern itself could simply be caused by the frequency of CV observed by magnified endoscopy in the gastric antral mucosa without H pylori infection. This will no doubt prove to be a fundamental piece of evidence that will help endoscopists interpret the magnified endoscopic findings of the microvascular architecture of the stomach. To the Editor: I read with great interest the article by Nakagawa et al.1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar on the usefulness of magnifying endoscopy for the diagnosis of Helicobacter pylori–induced histopathologic gastritis. They classified the morphologic characteristics of the collecting venula (CV) as visualized by magnification into 3 patterns; regular (R), irregular, and obscure. The cases with the R pattern CV were negative for H pylori infection at all sites observed with a magnifying endoscope. Therefore, the R pattern is a good predictor for H pylori-negative status. I consider that these results are indeed reliable and provide a more objective method for predicting the absence of H pylori infection than non-magnified endoscopic observation alone. However, further discussion is needed regarding certain results in the study of Nakagawa et al.1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar The sensitivity of the R pattern for negative H pylori status differed between the gastric antrum and body. In the antral mucosa, the sensitivity was low (30.6%), whereas, it was high (63.9%-66.7%) in the gastric body. This difference in sensitivity could originate simply from differences in the normal microvascular architecture of the stomach. As reported with regard to histopathologic findings2.Gannon B. The vasculature and lymphatic drainage.in: Whitehead R. Gastrointestinal and oesophageal pathology. Churchill Livingstone, Edinburgh1995: 129-199Google Scholar and magnified observations,3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar there are two distinctly different patterns of mucosal microvascular architecture between the gastric antrum and body as visualized by magnifying endoscopy. In the body mucosa without pathologic change, magnifying endoscopy demonstrates a honeycomb-shaped subepithelial capillary network pattern surrounding gastric pits, and this pattern is constantly accompanied by CV in a regular arrangement.3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar, 4.Yagi K. Nakamura A. Seike A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection.J Gastroenterol Hepatol. 2002; 17: 39-45Crossref PubMed Scopus (138) Google Scholar However, in the antral mucosa, a coil-shaped subepithelial capillary network pattern is observed in relatively elevated apical parts between the antral gastric sulci and pits, but this pattern is rarely accompanied by CVs.3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar It has been suggested that because the CVs of the antral mucosa are located at a relatively deeper site from the surface epithelium compared with those of the body mucosa,2.Gannon B. The vasculature and lymphatic drainage.in: Whitehead R. Gastrointestinal and oesophageal pathology. Churchill Livingstone, Edinburgh1995: 129-199Google Scholar, 3.Yao K. Oishi T. Microgastroscopic findings of mucosal microvascular architecture as visualized by magnifying endoscopy.Dig Endosc. 2001; 13: S27-S33Crossref Google Scholar the CV cannot be observed optically, even in H pylori–negative gastric antral mucosa. These basic anatomical characteristics should be taken into consideration when interpreting the magnifying endoscopic findings of the mucosal microvasculature. Accordingly, the low sensitivity of the R pattern in antral mucosa without H pylori infection, as observed in the study of Nakagawa et al.,1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar is simply because of the normal anatomical arrangement, which accounts for the low frequency of visualization of CV in the antral mucosa itself. The results of Nakagawa et al.,1.Nakagawa S. Kato M. Shimizu Y. Nakagawa M. Yamamoto J. Luis A. et al.Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.Gastrointest Endosc. 2003; 58: 71-75Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar on the other hand, do provide an additional important fact; to date, there has been no study reported that verifies the frequency of collecting venulae in the antral mucosa without H pylori infection as visualized by magnifying endoscopy. The sensitivity (30.6%) of the R pattern itself could simply be caused by the frequency of CV observed by magnified endoscopy in the gastric antral mucosa without H pylori infection. This will no doubt prove to be a fundamental piece of evidence that will help endoscopists interpret the magnified endoscopic findings of the microvascular architecture of the stomach.