The New Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (NIEC) developed consensus criteria for the endoscopic grading of portal hypertensive gastropathy (PHG).
Elementary lesions:
(1) mosaic-like pattern (MLP)
(2) red-point lesions (RPL)
(3) cherry-red spots (CRS)
(4) black-brown spots (BBS)
Elementary Lesion
Description
mosaic-like pattern
small polygonal areas surrounded by a whitish-yellow depressed border
red-point lesions
small, flat red-point-like lesions < 1 mm in diameter
cherry-red spots
red-colored round lesions > 2 mm in diameter, slightly protruding into the gastric lumen
black-brown spots
black or brown irregular flat spots that persist after washing with water
where:
• Black-brown spots are associated with intramucosal hemorrhage
Mosaic-like Pattern
Description
mild
areola is uniformly pink
moderate
center red with pink areaola
severe
areaola uniformly red
Mosaic-Like Pattern
RPL, CRS or BBS
Grade of PHG
present
absent
mild
present or absent
present
severe
Performance:
• The kappa statistic shows a fair-to-good interobserver agreement.
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