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Background <p>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.</p> Methods <p>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.</p> Results <p>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).</p> Conclusions <p>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.</p>

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

  • 期刊论文

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  • 发表日期：

    2026年4月1日

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

摘要

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.