Background: In a previous study, we demonstrated the collaterals around the esophageal wall observed by endoscopic ultrasound (EUS) in patients with portal hypertension can be divided into two groups, peri-esophageal collateral veins (peri-ECVs) and para-esophageal collateral veins (para- ECVs), and that the peri-ECVs and the perforating veins play an important role in the development of esophageal varices (Gastrointestinal Endosc 1999;50). Aim: To compare EUS imaging with microscopic findings in the peri- and para-ECVs and the perforating veins. Patients and Methods: Four patients with esophageal varices treated by endoscopic injection sclerotherapy were studied. After the therapy, the esophago-gastric junction (EGJ) to the upper 5 cm was scanned by EUS. In autopsy, the esophagus with surrounding tissue was removed, and 1 cm cross sections of the EGJ to the upper 5 cm were cut. EUS imaging and microscopic findings were compared. Results: EUS showed that peri-ECVs were developed in all cases and that para-ECVs were developed in 3 cases. Perforating veins were visualized in all cases. On the basis of microscopic findings in autopsy, the collaterals around the esophageal wall were divided into two groups: collaterals adjacent to the muscularis externa of the esophagus, and collaterals distal to the esophageal wall without contact with the muscularis externa. These collaterals were observed in all cases and were considered to correspond to the peri- and para-ECVs observed by EUS. Veins connecting vessels in the submucosal layer and veins around the esophageal wall were observed in all cases. These veins were considered to correspond to the perforating veins observed by EUS. Conclusion: The veins corresponding to peri-ECVs, para-ECVs and perforating veins observed by EUS were identified in autopsy. EUS has shown to be useful for an understanding of vascular structure around the esophageal wall.