Oesophageal and gastric varices classifications

SARIN CLASSIFICATION FOR GASTRIC VARICES

The 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