Vessels Affected in Cirrhosis Varices

Esophageal Varices

• Esophageal varices develop in approximately 50% of patients with cirrhosis and are the most common type of varices 2
• The prevalence of esophageal varices correlates with the severity of liver disease: present in 40% of Child A patients but in 85% of Child C patients 2
• Patients without varices develop them at a rate of 8% per year, with an HVPG ≥10 mmHg being the strongest predictor for development 2, 4

Gastric Varices

• Gastric varices are less prevalent than esophageal varices, occurring in 5-33% of patients with portal hypertension 5, 4
• Gastric varices are classified into two main categories: Gastroesophageal varices (GOV) and Isolated gastric varices (IGV) 1, 5

Pathophysiology of Variceal Formation

• Portal hypertension develops initially due to increased resistance to blood flow caused by architectural distortion of the liver from fibrous tissue and regenerative nodules 2
• Varices develop when the hepatic venous pressure gradient (HVPG) exceeds 10-12 mmHg 2, 6

Risk Factors for Variceal Bleeding

• Size of varices (large varices >5 mm have highest risk) 5, 4
• Decompensated cirrhosis (Child B/C classification) 5, 4, 6
• Presence of red wale marks or red spots on varices 5, 4, 6
• Higher portal pressure gradient (HVPG >20 mmHg) 5, 6

Clinical Implications

• Variceal hemorrhage occurs at a yearly rate of 5-15%, with mortality of at least 20% at 6 weeks 5, 4
• Patients with HVPG ≥20 mmHg have higher risk of early rebleeding (83% vs 29%) and higher 1-year mortality (64% vs 20%) 5, 4