Intra-mural distribution of the blood vessels in the stomach demonstrated by contrast medium injection: a cadaver study

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 43; no. 3; pp. 389 - 396
• Main Authors: Eishi, Haruka, Yamaguchi, Kumiko, Hiramatsu, Yoshihiro, Akita, Keiichi
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.03.2021; Springer Nature B.V
• Subjects: Accuracy; Anatomy; Arteries; Blood vessels; Cadavers; Cancer screening; Contrast media; Fluoroscopy; Gastric cancer; Imaging; Injection; Invasiveness; Medical screening; Medicine; Medicine & Public Health; Mucosa; Original Article; Orthopedics; Radiology; Salicylic acid; Surgery; Veins; Gastric veins; Submucosal gastric vessels; Gastric arteries; X-ray imaging; Double contrast study
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-020-02613-5

Purpose With advances in diagnostic imaging techniques of gastric cancer screening with X-ray fluoroscopy, it has been suggested that mucosal projections induced by the vessels distributed in the submucosal layer of the stomach may be mistaken for abnormal mucosal folds. In this study, we aimed to describe the distribution of blood vessels in the submucosal layer of the stomach to improve the diagnostic accuracy of screening of gastric cancer. Methods Twenty-four stomachs from Japanese cadavers were used in this study. Uncolored or colored contrast agents were injected into arteries and/or veins for macroscopic analyses, X-ray imaging, and methyl salicylate clearing. In addition, histological analysis was performed to examine blood vessels distributed inside the stomach wall. Results Following contrast agent injection, thick blood vessels were distributed perpendicular to both curvature sides, and branches parallel to both curvature sides flowed from these thick blood vessels, and a vascular network was formed throughout the stomach wall. This vascular network had intra-mural anastomoses connecting both curvature sides. Moreover, in histological analyses, blood vessels depicted by injection were mainly distributed in the submucosal layer. Conclusion This study strongly suggests that the mucosal projections induced by arteries and veins in the submucosal layer could be mistaken for abnormal mucosal folds. Therefore, a better understanding of the vascular distribution in the submucosal layer is important to improve diagnostic accuracy from imaging studies of the stomach. The information provided by this research may facilitate better accuracy in diagnosis and reduce the number of unnecessary invasive procedures.