Esophageal Varices Management Based on Japanese Grading System

Introduction to Japanese Grading System

The Japanese grading system for esophageal varices uses two primary parameters: Form (F) and Red Color signs (RC), which differ from the Western simplified small/large classification, as noted by the American Association for the Study of Liver Diseases 1, 2, 3, 4.

For patients with no varices (F0) and compensated cirrhosis, the American College of Gastroenterology recommends repeat endoscopy every 2-3 years, and annually for decompensated cirrhosis 6, 7.
For patients with small varices (F1) and prominent red color signs (RC2), the American Association for the Study of Liver Diseases suggests initiating prophylactic treatment immediately with either nonselective beta-blockers or endoscopic variceal ligation, as the presence of RC2 signs indicates a high risk of bleeding 5.
For patients with medium to large varices (F2-F3), all patients require prophylactic treatment, which may include nonselective beta-blockers, carvedilol, endoscopic variceal ligation, or a combination of these treatments, as recommended by the American College of Gastroenterology 1, 2, 3, 4, 5, 7.

The Japanese system identifies three independent risk factors for hemorrhage: variceal size, red color signs, and degree of hepatic decompensation, highlighting the importance of a comprehensive assessment, according to the American Association for the Study of Liver Diseases 5.
Following endoscopic variceal ligation, the American Society for Gastrointestinal Endoscopy recommends follow-up endoscopy at 1-6 months after variceal eradication, then every 6-12 months, to monitor for variceal recurrence 5.
The American Heart Association notes that patients on beta-blockers should be monitored for heart rate targets and medication tolerance to ensure optimal prophylaxis 5.