Journal of Gastroenterology

, Volume 44, Issue 8, pp 842–846 | Cite as

Can Western endoscopists identify the end of the lower esophageal palisade vessels as a landmark of esophagogastric junction?

  • Chika KusanoEmail author
  • Tonya Kaltenbach
  • Taichi Shimazu
  • Roy Soetikno
  • Takuji Gotoda
Original Article—Alimentary Tract


Background and aim

The endoscopic landmark of esophagogastric junction (EGJ) for diagnosis of Barrett’s esophagus (BE) differs between Japan and Western countries. Japanese endoscopists use the distal end of the lower esophageal palisade vessels to localize EGJ. In the West, endoscopists use the proximal gastric folds because of concerns that palisade vessels may be difficult to recognize. We evaluated whether there were differences between American and Japanese endoscopists in the recognition of palisade vessels.


A total of 82 patients were enrolled in this study. Patients were referred for diagnostic esophagogastroduodenoendoscopy (EGD) at the Veterans Affairs Palo Alto Health Care System, from May to July 2008. American and Japanese endoscopists evaluated the EGJ of patients undergoing diagnostic EGD. We analyzed the differences in the recognition of the distal end of palisade vessels. We calculated the kappa statistic to measure interobserver variability.


Based on localization using the distal end of the palisade vessels, American and Japanese endoscopists identified the EGJ in 87.8% (72/82) and 89.0% (73/82) of cases, respectively. The kappa statistic for visualization of EGJ was 0.88 [95% confidence interval (CI): 0.73–1.00].


American and Japanese endoscopists similarly recognized the distal end of palisade vessels as EGJ.


Barrett’s esophagus Endoscopic diagnosis Palisade vessels Short segment Barrett’s esophagus 



The authors thank Dr. Shai Friedland, Tohru Sato, attending fellows, and all of medical staffs who belong to the section of GI endoscopy, Veterans Affairs Palo Alto Health Care System.

Conflict of interest statement

None declared.


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Copyright information

© Springer 2009

Authors and Affiliations

  • Chika Kusano
    • 1
    Email author
  • Tonya Kaltenbach
    • 2
  • Taichi Shimazu
    • 3
  • Roy Soetikno
    • 2
  • Takuji Gotoda
    • 1
  1. 1.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Division of Gastroenterology, Department of Medicine, Veterans Affairs Palo Alto Health Care SystemStanford University School of MedicinePalo AltoUSA
  3. 3.Epidemiology and Prevention Division, Research Center for Cancer Prevention and ScreeningNational Cancer CenterTokyoJapan

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