Gastrointestinal varices classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Classification

Classification of esophageal varices

The following table outlines the major classification schemes for esophageal varices, based on grades:

Classification system	Grade	Interpretation of grade
Dagradi classification	1	Blue or red discoloration of varices Become prominent on compression of esophageal wall by esophagoscope Linear/sigmoid shaped < 2 mm in diameter
	2	Bluish in color 2–3 mm in diameter Mildly tortuous or straight Elevated above the surface or the relaxed oesophagus
	3	Prominently elevated bluish veins 3–4 mm in diameter Straight or tortuous
	4	Bluish varices > 4 mm in diameter, which completely surround the oesophageal lumen and almost meet in the mid-lumen Tortuous Closely packed around the wall With or without mucosal cover
	5	Grape-like appearance Occlude the lumen of the advancing oesophagoscope Presence of small, cherry-red varices on top of a base of bluish varices
Conn's classification	I	Varices visible during only one phase of respiration
	II	Varices visible during both phases of respiration
	III	3-6 mm in diameter
	IV	> 6 mm in diameter
Paquet’s classification	I	Microcapillaries located in : Distal oesophagus Esophago-gastric junction
	II	1-2 variceal vessels located in the distal esophagus
	III	Medium-sized varices of any number.
	IV	Large-sized varices in any part of esophagus
Westaby classification	1	Varices protruded above mucosa May be depressed with insufflations.
	2	Varices covering <50% of the lumen
	3	Varices covering >50% of the lumen
Soehendra classification	I	Mild dilatation Diameter <2 mm More prominent on flexing the neck forward
	II	Moderate dilatation Tortuou Diameter 3–4 mm Located in the lower part of the esophagus
	III	Total dilatation Diameter >4 mm Thin-walled Varices superimposed on varices Located in the gastric fundus
	IV	Total dilatation Found in the entire oesophagus Simultaneous presence of gastric or duodenal varices
Calès classification	1	Varices flattened by insufflations
	2	Varices not flattened by insufflations
	3	Confluent esophageal varices not flattened by insufflations

Classification of gastric varices

Classification system	Grade	Interpretation of grade
Hoskins and Johnson’s classification	1	Extension of esophageal varices across the squamo-columnar junction
	2	Varices located in gastric fundus Overlap with esophageal varices in the esophagus at cardia
	3	Gastric varices in gastric fundus or body No esophageal varices
Mathur’s classification	1	Esophageal varices with lesser curvature varices
	2	Esophageal varices with gastric fundal varices 2a – Subcardiac 2b – Diffuse fundal
	3	Isolated fundal varix 3a – Secondary to splenic vein thrombosis 3b – Secondary to generalized portal hypertension
	4	Lesser curvature gastric varices Esophageal varices along with varices located in the gastric fundus
	5	Varices in the gastric antrum
Hashizume’s classification	Form	Three forms: F1: Tortuous F2: Nodular F3: Tumorous
	Location	Five common locations: La: Anterior Lp: Posterior Ll: Lesser curvature of the stomach L: Greater curvature cardiac of the stomach Lf: Fundic areas of the stomach
	Color	Three colors: Cr: Red Cw: White RCS: Thin-walled focal redness on the varix as red colored spot
Sarin’s classification	Gastro-esophageal type 1	Esophageal varices spreading into the lesser curvature of the stomach
	Gastro-esophageal type 2	Esophageal varices spreading into the greatercurvature of the stomach
	Isolated gastric type 1	Varices in the gastric fundus and cardia without esophageal varices
	Isolated gastric type 2	Varices outside of cardio-fundal region or first part of duodenum