The Sarin classification identifies two types of gastroesophageal varices: varices found where esophageal varices are present, and two types of isolated gastric varices found without esophageal varices present. The classification system grades esophageal varices based on their size as small, medium, or large. The AASLD recommends simplifying this to a two-grade system of small or large varices based on a 5 mm cutoff. The North Italian Endoscopic Club classification scores varices based on size, severity of red wale marks, and Child-Pugh class to define a risk of bleeding.

2. SARIN CLASSIFICATION FOR GASTRIC VARICES
The Sarin classification of gastric varices
identifies two types of gastro esophageal
varices
where esophageal varices are found concurrently
two types of isolated gastric varices, found in the
absence of esophageal varice

3. SARIN CLASSIFICATION

8. OESOPHAGEAL VARICES
Endoscopic appearance and liver function
In most centres using OGD,
oesophageal varices are graded according to their size
Small (Grade 1): small straight varices
Medium (Grade 2): enlarged tortuous varices occupying less
than one third of the lumen
Large (Grade 3): large coil-shaped varices occupying more
than one third of the lumen.

11. American Association for the Study of Liver
Diseases (AASLD)
includes a recommendation to simplify this using
2 grades (small and large) with a cut-off size of
5 mm.
As a consequence, all the recommendations for
large varices will apply also to medium varices
for centres using the 3-grade classification.

12. TWO VS THREE GRADE CLASSIFICATION
SYSTEM

13. AASLD provide a framework for both treatment
and surveillance endoscopy:
• Patients with cirrhosis and no varices
• Patients with cirrhosis and small varices that
have not bled
• Patients with cirrhosis and medium/large
varices that have not bled
• Patients with cirrhosis and an acute episode of
variceal haemorrhage
• Patients with cirrhosis who have recovered
from variceal haemorrhag

14. NORTH ITALIAN ENDOSCOPIC CLUB FOR THE
STUDY AND TREATMENT OF OESOPHAGEAL
VARICES
Classification based on size, severity of red wale marks, and Child-
Pugh class:
A risk stratification for variceal bleeding accompanies this
classification, with cumulative scores for individual features
added to define a risk class.
Size of varices
Small (<25% lumen radius) 8.7
Medium (25 to 50% lumen radius) 13.0
Large (>50% of lumen radius) 17.4

15. Red wale markings
Absent
Mild
Moderate
Severe

16. Red wale markings
Absent
Mild
Moderate
Severe

17. Child-Pugh class
A
B
C