Journal of Research in Medical Sciences | December 2015 | 1200 Gastric varices: Classification, endoscopic and ultrasonographic management Zeeshan Ahmad Wani, Riyaz Ahmad Bhat 1 , Ajeet Singh Bhadoria 2 , Rakhi Maiwall, Ashok Choudhury Departments of Gastroenterology, ILBS, New Dehli, 1 Health and Medical Education Department, Health Services, Kashmir, 2 Preventive Medicine, ILBS, New Dehli, India CLASSIFICATION OF GASTRIC VARICES There are three types of classifcation commonly used for GV. 1. Sarin’s classifcation 2. Hashizome classifcation 3. Arakawa’s classifcation. Most commonly used classifcation is Sarin’s classifcation of GV. SARIN’S CLASSIFICATION Gastric varices are categorized into four types based on the relationship with esophageal varices, as well as by their location in the stomach [Figure 1]. [7] a. Gastroesophageal varix (GOV) type 1: Extension of esophageal varices along lesser b. Gastroesophageal varix type 2: Extension of esophageal varices along great curve c. Isolated gastric varix (IGV) type 1 and d. Isolated gastric varix type 2: Varices in stomach or duodenum as shown in fgure. Gastroesophageal varix type 1 is the most common type, accounting for 74% of all GV. However, the incidence of bleeding is highest with IGV type 1, followed by GOV type 2. Overall, the most important predictor of hemorrhage is the size of varices, with the highest risk of frst hemorrhage (15%/year) occurring in patients INTRODUCTION Gastroesophageal varices have been seen in approximately 50% of patients with cirrhosis of the liver. Their presence correlates with the severity of liver disease. While only 40% of Child A patients has varices, they are present in 85% of Child C patients. [1,2] Variceal hemorrhage occurs at a yearly rate of 5-15%, and 6-week mortality afer variceal hemorrhage is about 20%. [3,4] In general, variceal bleeding ceases spontaneously in 40-50% of patients, but incidence of early rebleeding ranges between 30% and 40% within frst 6 weeks, and about 40% of all rebleeding episodes occur within the frst 5 days. [5,6] Gastric varices (GV) bleed less frequently than esophageal varices and are responsible for 10-30% of all variceal hemorrhages. [7] However, gastric variceal bleeding tends to be more severe with higher mortality. In addition, a high proportion of patients, around 35-90%, rebleed after spontaneous hemostasis. New endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for GV. This review provides an overview of the classifcation and pathophysiology of GV, which have direct consequences for management; an introduction to current endoscopic and interventional radiological management options for GV. Gastric varices (GV) are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV. Key words: Endoscopic treatment, gastroesophageal varices, sclerotherapy Address for correspondence: Dr. Riyaz Ahmad Bhat, Lane No 3, Galib Abad, Srinagar, Jammu and Kashmir, India. E-mail: bhatdrriaz@hotmail.com Received: 16-03-2015; Revised: 27-04-2015; Accepted: 26-05-2015 Review ARticle How to cite this article: Wani ZA, Bhat RA, Bhadoria AS, Maiwall R, Choudhury A. Gastric varices: Classifcation, endoscopic and ultrasonographic management. J Res Med Sci 2015;20:1200-7.