score/[id]

Form — F0 (no varicose appearance) / F1 (straight, small-caliber) / F2 (beady) / F3 (nodular or tumor-shaped)

Location — esophagus Ls / Lm / Li; stomach Lg-c / Lg-cf / Lg-f

Color — Cw (white) / Cb (blue)

Write L, F, C, then RC, bleeding signs, and mucosal findings

From the esophageal orifice to the tracheal bifurcation

The middle esophagus

The lower esophagus, including the abdominal esophagus

Cardiac varices adjacent to the cardiac orifice (roughly Sarin GOV1)

Cardiofornical varices involving both the cardia and the fundus (roughly Sarin GOV2)

Fundal varices localized in the gastric fundus, away from the cardia (roughly Sarin IGV1)

Lesions that lack a varicose appearance. Used to record disappearance after treatment, even if red veins or blue veins remain

Straight, small-caliber varices. Small venous dilatations that disappear on insufflation of the esophagus are not included

Corresponds to small varices in Baveno / AASLD (often <5 mm)

Moderately enlarged, beady varices

Corresponds to large varices in Baveno / AASLD

Markedly enlarged, nodular or tumor-shaped varices

White varices that look like large folds of the esophageal mucosa

Bluish or cyanotic varices; the covering mucosa appears thin. High-risk varices have a tense appearance like an over-inflated balloon

Absent

Small in number and localized

Intermediate between RC1 and RC3

Large in number and circumferential

Red wale markings — dilated venules oriented longitudinally on the mucosal surface, somewhat like wale or whip marks

Cherry-red spots — small red spots on the mucosal surface

Hematocystic spots — large, round, crimson-red projections that look like blood blisters

Gushing, spurting, or oozing

Red plug or white plug after hemostasis

E (erosion), Ul (ulcer), S (scar)

An endoscopic red color sign is a risk factor for esophagogastric variceal bleeding (JSGE/JSH Liver Cirrhosis 2020, BQ 4-1). AASLD / EASL treat even small (about F1) varices with RC as an indication for prophylaxis. Baveno VI also lists Child–Pugh C as a bleeding-risk factor.

In Japan, endoscopic therapy (EVL or EIS) is first-line for high-risk esophageal varices. In the West, a non-selective beta-blocker is often first. Either EVL or EIS is suggested for secondary prevention (CQ 4-5).

Cardiac / GOV1 varices are treated like esophageal varices. Isolated fundal varices (Lg-f / IGV1): BRTO is suggested to prevent rebleeding; cyanoacrylate may be used for never-bled fundal varices. After bleeding, BRTO is preferred over cyanoacrylate (CQ 4-6, CQ 4-7).