Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place

Abstract

Variceal disease and its management are of the utmost importance in the treatment of portal hypertension. Current guidelines are universal for management of variceal disease in portal hypertension. Classification and grading systems are numerous and differ according to geographical location. In this exhaustive review, the historical aspects of variceal disease, its classification and the grading systems in use are discussed, with self-explanatory tables and timelines. A better and clear understanding of the evolution of portal hypertension and variceal disease is provided.

Keywords: classification; gastric varices; oesophageal varices; portal hypertension.

Figure 2.

A) Grade 3 oesophageal varix with large ulcer; B) Post-band ligation status, EVL ulcer with active oozing; C) White nipple sign over an oesophageal varix—stigmata of recent haemorrhage; D) Red nipple sign over an oesophageal varix—red platelet plug, stigmata of recent haemorrhage; E) Large haemocystic spot, a high-risk sign for bleeding; F) Ruptured oesophageal varix with overlying ulcer and active ooze; G) Gushing bleed (as per Japanese Society classification) from large oesophageal varices (grade 4 classification as per Conn’s classification and Dagradi classification); H) Spurting grade 2 oesophageal varix.

Figure 1.

A) Small oesophageal varices (grade 1, form F1); B) Small and beady oesophageal varices (grade 2, form F2); C) Large oesophageal varices (grade 3, form F3); D) Large white oesophageal varices that look like mucosal folds; E) Grade 3 oesophageal varices with red colour signs (whip-like red wale marks); F) Large oesophageal varices with red colour signs (cherry red spots and red wale marks); G) Diffuse red colour signs (red wale marks) over oesophageal varices; H) Large oesophageal varices with diffuse redness.

Figure 3.

A) Large GOV2 (along greater curvature; also note the small ulcer on the surface, post glue therapy) with diffuse red colour signs; B) Large GOV1 (along lesser curvature of stomach); C) Large IGV1 with cherry red spot (form 3, tumorous); D) Large GOV1 with a haematocystic spot on the surface.

Figure 4.

A) Bunch of GOV2 with active ooze from surface ulcer; B) Multiple site spurting from GOV2; C) End on view of a spurting GOV1 (along lesser curvature); D) Oozing IGV1 with adherent clot on the surface; E) Oozing GOV2 with adherent clots; F) Post-glue injection into a bleeding GOV1.

Figure 5.

Timeline of historical events in classification and grading of oesophageal and gastric varices.