Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1728222
New Classification of Gastric Varices: A Twenty-Year Experience
![](https://www.thieme-connect.de/media/10.1055-s-00043283/202101/lookinside/thumbnails/10-1055-s-0041-1728222_9_0008-1.jpg)
Abstract
Objectives Gastric varices (GV) have been classified by the Sarin classification for over two decades. However, a subset of these varices does not fit into this classification. We share our experience on GV in past 20 years and propose a modification.
Materials and Methods Consecutive patients with portal hypertension (PHT) posted for esophagogastroduodenoscopy were screened for GV between 1996 and 2016 at a tertiary-care hospital. GV were categorized as gastroesophageal varices (GOV1, GOV2) and isolated gastric varices (IGV1, IGV2) by Sarin’s classification. Patients with varices in esophagogastric region as well as distally in the stomach or duodenum, thus having efferent drainage into the superior as well as inferior vena cava simultaneously, remain unclassified and were coined as GOV3.
Statistical Analysis Descriptive data was represented as mean (standard deviation) or median (interquartile range) or number (percentage). Chi-squared test, t-test, and logistic regression were done to compare groups and identify outcomes of interest.
Results GV were recognized in 400 (11.5%) of 3,476 patients with PHT. Underlying disease was cirrhosis in 301 (75.2%), extrahepatic portal venous obstruction in 78 (19.5%), noncirrhotic portal fibrosis in 18 (4.5%) and Budd–Chiari syndrome in 3 (0.75%) patients with GV. GOV1, GOV2, IGV1, IGV2, and combined GOV1 with GOV2 were seen in 170 (42.5%), 154 (38.5%), 17 (4.3%), 5 (1.3%), and 12 (3.0%) patients; respectively. GOV3 were identified in 42 (10.5%) patients. Ninety-three patients with GV presented with gastrointestinal bleed and frequency of GOV2 was higher and GOV1 and GOV3 were lower among bleeders than non-bleeders.
Conclusions A significant proportion of patients with GV remain uncategorized by current classification among PHT patients. Addition of GOV3 in Sarin’s classification will make it more comprehensive, uniform, and reproducible for future studies.
Publication History
Article published online:
17 April 2021
© 2020. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
- 2 Hashizume M, Kitano S, Yamaga H, Koyanagi N, Sugimachi K. Endoscopic classification of gastric varices. Gastrointest Endosc 1990; 36 (03) 276-280
- 3 Hosking SW, Johnson AG. Gastric varices: a proposed classification leading to management. Br J Surg 1988; 75 (03) 195-196
- 4 Arakawa M, Masuzaki T, Okuda K. Pathomorphology of esophageal and gastric varices. Semin Liver Dis 2002; 22 (01) 73-82
- 5 Mathur SK, Dalvi AN, Supe AN, Ramakantan R, Someshwar V. Endoscopic and radiological appraisal of gastric varices. J Gastroenterol Hepatol 1989; 4 (Suppl. 01) 245-247
- 6 de Franchis R. Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (03) 743-752
- 7 Sarin SK. Non-cirrhotic portal fibrosis. Gut 1989; 30 (03) 406-415
- 8 Sarin SK, Sollano JD, Chawla YK. et al. Members of the APASL Working Party on Portal Hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26 (05) 512-519
- 9 Valla DC. Budd-Chiari syndrome/hepatic venous outflow tract obstruction. Hepatol Int 2018; 12 (Suppl. 01) 168-180
- 10 Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices – a prospective controlled randomized trial. Endoscopy 1982; 14 (01) 4-5
- 11 Zhao L-Q, He W, Ji M, Liu P, Li P. 64-row multidetector computed tomography portal venography of gastric variceal collateral circulation. World J Gastroenterol 2010; 16 (08) 1003-1007
- 12 Saad WE. Vascular anatomy and the morphologic and hemodynamic classifications of gastric varices and spontaneous portosystemic shunts relevant to the BRTO procedure. Tech Vasc Interv Radiol 2013; 16 (02) 60-100
- 13 Sarin SK, Jain AK, Lamba GS, Gupta R, Chowdhary A. Isolated gastric varices: prevalence, clinical relevance and natural history. Dig Surg 2003; 20 (01) 42-47