New Classification of Gastric Varices: A Twenty-Year Experience

Abstract

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.