From: Beyond the scope and the glue: update on evaluation and management of gastric varices
Classification system | Clinical relevance |
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Kiyosue classification | In Type A, shunt occlusion as the treatment of modality would suffice to control variceal bleeding not controlled with endoscopic therapy. In type B, feasibility of shunt occlusion might be less and hence transjugular intrahepatic portosystemic shunt placement is a better option to obliterate all of the collateral pathways In type C, transjugular intrahepatic portosystemic shunt placement along with shunt emobilization of large portosystemic shunts could be the best option in ideal candidates In Type D, in the presence of endoscopic failure, transjugular intrahepatic portosystemic shunt placement could become the best option |
Type A: single draining shunt Type B: single shunt and multiple collateral veins B1: small collateral veins B2: medium sized collateral B3: large collateral veins with high flow without shunt Type C: more than one shunt present C1: small sized second shunt that cannot be catheterized C2: presence of second shunt large enough to be catheterized Type D: shunt is not present and the varices drain through small collaterals | |
Saad–Caldwell classification | In Type D, embolization procedures may not suffice to prevent rebleeding or control active bleeding due to the complex anatomy, and hence, transjugular intrahepatic portosystemic shunt placement could become the best option for prevention of further bleeding |
Type A: single draining shunt Type B: single shunt and multiple collateral veins B1: small collateral veins B2: medium sized collateral B3: large collateral veins with high flow without shunt Type C: more than one shunt present C1: small sized second shunt that cannot be catheterized C2: presence of second shunt large enough to be catheterized Type D: shunt is not present and the varices drain through small collaterals D1: predominance of systemic vein drainage is not obvious and any vein, out of inferior phrenic, hemiazygos tributaries, and intercostals veins or adrenal veins may be predominant D2: morphology similar to D1, but predominant systemic venous draining vein is usually 4.3Â mm in diameter through unconventional systemic veins | |
Hirota—BORV classification | In Type A, shunt embolization can help obliterate gastric varices In Type B, transjugular intrahepatic portosystemic shunt placement with or without shunt embolization can help obliterate varices In Type C, transjugular intrahepatic portosystemic shunt placement and shunt embolization need to be performed for large shunts for complete variceal disease management In Type E, an antegrade approach for shunt embolization is more feasible than a retrograde approach since balloon sizes may not be available and the shunt flow is high |
Type A: single draining shunt Type B: single shunt and multiple collateral veins B1: small collateral veins B2: medium sized collateral B3: large collateral veins with high flow without shunt Type C: more than one shunt present C1: small sized second shunt that cannot be catheterized C2: presence of second shunt large enough to be catheterized Type D: shunt is not present and the varices drain through small collaterals Type E: gastrorenal shunt too large for balloon occlusion procedures |