The risk of bleeding from gastric fundal varices in patients with cirrhosis can be predicted from clinical and endoscopic findings. The most important risk for factor for bleeding is the size of the fundal varices, similar to the increase risk seen in esophageal varices and reflecting the increased pressure and blood flow within the variceal vessels.
Parameters:
(1) Child-Pugh's classification for cirrhosis
(2) size of the fundal varices
(3) red spot sign on endoscopy (corresponds to the dilated, blood filled channels lying within and beneath the mucosal epithelium)
|
Parameter |
Finding |
Points |
|
Child's status |
Class A |
0 |
|
|
Class B |
1 |
|
|
Class C |
2 |
|
size of fundal varices |
small (< 5 mm) |
0 |
|
|
medium (5-10 mm) |
1 |
|
|
large (> 10 mm) |
2 |
|
red-spot on endoscopy |
absent |
0 |
|
|
present |
1 |
prognostic index =
= (0.53 * (points for Child's status)) + (0.78 * (points for size of varices)) + (0.72 * (points for red spot))
Interpretation:
• minimum score: 0
• maximum score: 3.34
• The higher the prognostic index, the higher the risk of bleeding from the fundal varices.
|
Child's Status |
Gastric Varices |
Red Spot |
Estimate 1 year probability of bleeding |
|
Class A |
small |
absent |
4% |
|
Class A |
small |
present |
7% |
|
Class A |
moderate |
absent |
8% |
|
Class A |
moderate |
present |
15% |
|
Class A |
large |
absent |
16% |
|
Class A |
large |
present |
30% |
|
Class B |
small |
absent |
6% |
|
Class B |
small |
present |
12% |
|
Class B |
moderate |
absent |
13% |
|
Class B |
moderate |
present |
24% |
|
Class B |
large |
absent |
26% |
|
Class B |
large |
present |
46% |
|
Class C |
small |
absent |
10% |
|
Class C |
small |
present |
20% |
|
Class C |
moderate |
absent |
21% |
|
Class C |
moderate |
present |
38% |
|
Class C |
large |
absent |
40% |
|
Class C |
large |
present |
65% |
Specialty: Gastroenterology
