OESOPHAGEAL A

ND

GASTRIC

VARIC

ES

CLASSIFI

CATIO

NS

DR

JA

WA

D A

L I

SARIN CLASSIFICATION FOR GASTRIC VARICESThe Sarin classification of gastric varices

identifies two types of gastro esophageal varices

where esophageal varices are found concurrently

two types of isolated gastric varices, found in the absence of esophageal varice

SARIN CLASSIFICATION

OESOPHAGEAL VARICES

Endoscopic appearance and liver function

In most centres using OGD,

oesophageal varices are graded according to their size

Small (Grade 1): small straight varices

Medium (Grade 2): enlarged tortuous varices occupying less than one third of the lumen

Large (Grade 3): large coil-shaped varices occupying more than one third of the lumen.

American Association for the Study of Liver Diseases (AASLD)

includes a recommendation to simplify this using 2 grades (small and large) with a cut-off size of 5 mm.

As a consequence, all the recommendations for large varices will apply also to medium varices for centres using the 3-grade classification.

TWO VS THREE GRADE CLASSIFICATION SYSTEM

AASLD provide a framework for both treatment and surveillance endoscopy:

• Patients with cirrhosis and no varices

• Patients with cirrhosis and small varices that have not bled

• Patients with cirrhosis and medium/large varices that have not bled

• Patients with cirrhosis and an acute episode of variceal haemorrhage

• Patients with cirrhosis who have recovered from variceal haemorrhag

NORTH ITALIAN ENDOSCOPIC CLUB FOR THE STUDY AND TREATMENT OF OESOPHAGEAL VARICES

Classification based on size, severity of red wale marks, and Child-Pugh class:

A risk stratification for variceal bleeding accompanies this classification, with cumulative scores for individual features added to define a risk class.

Size of varices

Small (<25% lumen radius) 8.7

Medium (25 to 50% lumen radius) 13.0

Large (>50% of lumen radius) 17.4

Red wale markings

Absent

Mild

Moderate

Severe

Red wale markings

Absent

Mild

Moderate

Severe

Child-Pugh class

A

B

C