Identification of the distal end of the palisade vessels under sedation: a multicenter prospective study in Japan

BACKGROUND: Although the distal end of palisade vessels (DEPV) has recently been proposed as an anatomically appropriate endoscopic landmark for defining the gastroesophageal junction (GEJ), its evidence under sedation remains limited. This study aimed to evaluate DEPV visualization under sedation, including its detectability and related factors. METHODS: This was a multicenter prospective cohort study conducted at 15 institutions across Japan. Patients underwent real-time endoscopic GEJ observation under sedation in three views: forward view on insertion, retroflex view, and forward view on withdrawal. The primary endpoint was the DEPV identification rate. The secondary endpoints included the DEPV identification rates across three sedation levels and factors associated with unsuccessful DEPV identification. RESULTS: A total of 638 patients were enrolled. The DEPV identification rate was highest in the forward view on insertion (77.0%). When the retroflex view and/or the forward view on withdrawal were additionally considered, the overall identification rate increased to 85.3%. The identification rate declined with deeper sedation, while combining all three views yielded identification rates ranging from 80.1% under deep sedation to 100% under minimal sedation. In multivariate analysis, risk factors for unsuccessful DEPV identification were deep sedation (odds ratio [OR], 3.83), reflux esophagitis (OR, 2.24-16.37), and incomplete GEJ distention (OR, 8.87), whereas hiatus hernia was protective (OR, 0.52). CONCLUSIONS: This largest multicenter prospective study demonstrated that early DEPV identification during insertion is most effective, whereas deep sedation adversely affects visualization, supporting a standardized approach for routine GEJ assessment.

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Journal
Journal of Gastroenterology
Published
2026-04-01
DOI
https://doi.org/10.1007/s00535-026-02385-6
Primary Topic
Anesthesia and Sedative Agents
Type
article
Field-Weighted Citation Impact
0.00

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article

Identification of the distal end of the palisade vessels under sedation: a multicenter prospective study in Japan

Shiko Kuribayashi, Naomi Kakushima, Satoshi Ono, Masakatsu Fukuzawa et al.
Journal of Gastroenterology
Anesthesia and Sedative Agents
article

Identification of the distal end of the palisade vessels under sedation: a multicenter prospective study in Japan

Shiko Kuribayashi, Naomi Kakushima, Satoshi Ono, Masakatsu Fukuzawa, Hideki Ishikawa, Yuto Shimamura, Yuji Ino, Yoshimasa Mıura, Tomoyuki Koike, Taro Iwatsubo, Mitsuhiro Fujishiro, Ai Fujimoto, Ayaka Takasu, Fumiaki Ishibashi, Tsutomu Takeda, Tomohiro Nakamura, Keiko Yamamoto, N. Nakaya, Chika Kusano, Atsushi Masamune, Kentaro Sugano, Yuji Urabe, Waku Hatta
article en

Abstract

BACKGROUND: Although the distal end of palisade vessels (DEPV) has recently been proposed as an anatomically appropriate endoscopic landmark for defining the gastroesophageal junction (GEJ), its evidence under sedation remains limited. This study aimed to evaluate DEPV visualization under sedation, including its detectability and related factors. METHODS: This was a multicenter prospective cohort study conducted at 15 institutions across Japan. Patients underwent real-time endoscopic GEJ observation under sedation in three views: forward view on insertion, retroflex view, and forward view on withdrawal. The primary endpoint was the DEPV identification rate. The secondary endpoints included the DEPV identification rates across three sedation levels and factors associated with unsuccessful DEPV identification. RESULTS: A total of 638 patients were enrolled. The DEPV identification rate was highest in the forward view on insertion (77.0%). When the retroflex view and/or the forward view on withdrawal were additionally considered, the overall identification rate increased to 85.3%. The identification rate declined with deeper sedation, while combining all three views yielded identification rates ranging from 80.1% under deep sedation to 100% under minimal sedation. In multivariate analysis, risk factors for unsuccessful DEPV identification were deep sedation (odds ratio [OR], 3.83), reflux esophagitis (OR, 2.24-16.37), and incomplete GEJ distention (OR, 8.87), whereas hiatus hernia was protective (OR, 0.52). CONCLUSIONS: This largest multicenter prospective study demonstrated that early DEPV identification during insertion is most effective, whereas deep sedation adversely affects visualization, supporting a standardized approach for routine GEJ assessment.

Journal of Gastroenterology
Nihon University (JP), Toho University (JP), Jichi Medical University (JP), Tokyo Medical University (JP), Gunma University (JP), Kyoto Prefectural University (JP), Tohoku University (JP), Kyoto Women's University (JP), Hokkaido University (JP), Juntendo University (JP), Toho University Omori Medical Center (JP), Hiroshima University Hospital (JP), Tohoku Medical Megabank Organization (JP), Tokyo Metropolitan Institute of Gerontology (JP), Koto Hospital (JP), Tokyo Metropolitan Geriatric Hospital (JP), Kitasato University (JP), The University of Tokyo (JP), International University of Health and Welfare (JP), Osaka University of Pharmaceutical Sciences (JP)
Jichi Medical University, Hokkaido University
Openalex Percentile: Top 32%
Anesthesia and Sedative Agents
DOIOpen Access PDFOpenAlex
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