Grade 4: Confluent varices remain identical with air insufflation and red signs (cherry, red spots, red wale markings, hematocytic spots,

telangiectasia and varices overlying spots)

Schäppi MG et al; Pediatric gastrointestnal disease, 2008; 1265-82

Sarin's classification for gastric varices

• GOV1: Gastroesophageal varices types 1, an extension of esophageal along the lesser covature

• GOV2: Gastroesophageal varices types 2, an extension of esophageal along the fundus

• IGV1: Isolated gastric varices in the fundus

• IGV2: Isolated gastric varices not in the fundus

Al-Osaimi AMS, Medical and Endoscopic Management of Gastric Varices, seminars in interventional radiology 28 (3) 2011

Initial Management

• Resuscitation (Hb 8g/dl)

• Medicine: Vasopressin, Somatostatin (Octreotide), β-blockers, PPI

• Endoscopy: Sclerotherapy; banding; ligation injection of cyanoacrylate glue for gastric varices

• Transjugular intrahepatic portosystemic shunts

• Surgery