Table 2 Hemodynamic classification of gastric varices based on balloon occluded transvenography
From: Beyond the scope and the glue: update on evaluation and management of gastric varices
Classification system | Clinical relevance |
|---|---|
Hirota classification | Only endoscopic guided or endoscopic ultrasound guided therapy may help in obliteration of varices of Type 1 and 2 Transjugular intrahepatic portosystemic shunt placement is ideal for Type 3 and 4 related bleeding Transjugular intrahepatic portosystemic shunt placement and shunt embolization is ideal in Type 5 |
Grade 1: gastric varices well opacified without any collateral vein evidence Grade 2: contrast opacification in gastric varices for ≥ 3 min in the presence of small and few collateral veins Grade 3: contrast opacification of gastric varices partial and disappears within 3 min with medium to large collateral veins which were few in number Grade 4: non-contrast opacification of gastric varices and presence of many large collaterals Grade 5: shunt cannot be occluded because of very large size of shunt and rapid blood flow | |
Fukuda classification | Based on hemodynamic features involving the superior mesenteric and celiac angiography findings In Type 2 and Type 3 with left gastric vein dominance, rebleeding can be noted with only endoscopic management and hence transjugular intrahepatic portosystemic shunt placement may become the treatment of choice In those associated with shunts, shunt embolization with or without transjugular intrahepatic portosystemic shunt placement may be superior to only endoscopic therapy |
Type 1: left gastric vein dominant gastric variceal complex Type 2: separation between the esophageal varices (left gastric vein dominant) and the gastric varices (posterior gastric vein/superior gastric vein dominant) Type 3: highly complex system consisting of both right and left sided feeding vessels Type 4: right sided dominance only of gastric variceal system | |
Matsumoto classification | Classification system for gastric varices for predicting the aggravation of esophageal varices after balloon occluded retrograde transvenous occlusion procedure Based on left gastric angiography Aggravation of esophageal varices grade occurs in Type 1B varices |
Type 1: portosystemic flow in the gastrorenal shunt A: hepatopetal flow B: hepatofugal flow Type 2: no portosystemic flow in the gastrorenal shunt A: hepatopetal flow B: hepatofugal flow |