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CLASSIFICATION
Classification
Sarin classification (gastric varices)
Splits gastric varices by continuity with esophageal varices and by site into GOV1 / GOV2 / IGV1 / IGV2. Japanese recording letters Lg-c / Lg-cf / Lg-f roughly match GOV1 / GOV2 / IGV1.
Classification overview
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Sarin
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GOV1 · Lesser-curve extension
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GOV2 · Fundal extension
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IGV1 · Isolated fundal
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IGV2 · Ectopic gastric
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JSPH letters
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Lg · JSPH gastric letters
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Japanese guidelines
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Guideline · JSGE / JSH 2020
Sarin
GOV1
Lesser-curve extension
Definition
Esophageal varices extending 2–5 cm below the gastro-oesophageal junction along the lesser curvature
Share
About 75% of gastric varices; lowest bleeding risk among the four types
Note: Roughly Lg-c. Vascular anatomy matches esophageal varices. Treat like the esophagus (EVL).
GOV2
Fundal extension
Definition
Esophageal varices extending into the fundus of the stomach along the greater curvature (cardiofundal)
Share
About 21% of gastric varices; higher bleeding risk than GOV1
Note: Roughly Lg-cf. Often has a gastrorenal shunt. Prefer cyanoacrylate or BRTO over banding.
IGV1
Isolated fundal
Definition
Isolated fundal varices without esophageal varices
Share
Less than 2% of gastric varices; highest bleeding risk of the four types
Note: Roughly Lg-f. Exclude splenic-vein occlusion (left-sided portal hypertension). Japanese guidelines suggest BRTO to prevent rebleeding.
IGV2
Ectopic gastric
Definition
Isolated varices in the gastric body, antrum, or pylorus (ectopic), away from the cardiofundal region
Share
About 4% of gastric varices
Note: No Lg letter. In Japan these are recorded as ectopic varices.
JSPH letters
Lg
JSPH gastric letters
Lg-c
Cardiac, adjacent to the cardiac orifice ≈ GOV1
Lg-cf
Cardia plus fundus ≈ GOV2
Lg-f
Fundus only, away from the cardia ≈ IGV1
Note: Form is F0–F3, color is Cw / Cb, and gastric RC is only RC0 / RC1. Full definitions are on the JSPH F / L / C page.
Japanese guidelines
Guideline
JSGE / JSH 2020
Risk
Location, form, red color sign, and liver reserve predict gastric variceal bleeding. An endoscopic RC sign is a bleeding-risk factor (BQ 4-1).
GOV1
Treat as esophageal varices (EVL / EIS).
Fundal
For isolated fundal varices, BRTO is suggested to prevent rebleeding (CQ 4-6). Cyanoacrylate injection improves outcomes for never-bled fundal varices; after bleeding, BRTO is preferred over cyanoacrylate (CQ 4-7).
Note: ESGE also recommends recording gastric varices with Sarin. The West uses NSBB for primary prophylaxis and CA / TIPS for bleeding. Japan has more BRTO experience.
Sarin 1992, Original
Acevedo 2019, Fig. 1, Not original, CC BY-NC
Reference
Original article
Sarin SK et al. Hepatology 1992;16:1343-1349
Japanese reference
JSGE/JSH cirrhosis guideline 2020 (gastric varices)
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Decision support only. Follow current guidelines and local protocols. Classification definitions and terminology follow the original publication language.