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21
MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
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  3. Sarin Classification
GI Bleeding

Sarin Classification

Endoscopic classification of gastric varices

GOV = gastro-oesophageal varices (continuous with oesophageal varices); IGV = isolated gastric varices (no oesophageal varices).

A descriptive endoscopic classification of gastric varices by location, not an additive score. Location predicts bleeding risk and directs treatment.

When to use
Use it whenever gastric varices are seen at endoscopy, to name the type precisely and let that name drive the treatment choice and the surrounding work-up. The distinction matters because gastric varices are managed differently from oesophageal ones, and the four Sarin types themselves diverge: a lesser-curve GOV1 is often handled like an oesophageal varix, whereas a fundal IGV1 needs glue injection or a radiological shunt and a deliberate hunt for splenic vein thrombosis. It classifies varices already visualised — it is not a screening tool for whether varices are present, which is what a score such as EVendo addresses.
Why use it
Because 'gastric varices' is too coarse a label to act on: location predicts both how likely the varix is to bleed and how it should be treated, and Sarin is the classification that encodes that. Isolated fundal varices behave very differently from a lesser-curve extension of oesophageal varices — different bleeding risk, different first-line therapy, different underlying causes — and a shared vocabulary is what lets an endoscopy report translate directly into a management plan. It is the classification embedded in the major portal-hypertension guidelines for exactly this reason.
Formula, evidence and interpretation

About the Sarin Classification of Gastric Varices

The Sarin classification sorts gastric varices by their location at endoscopy into four types. Gastro-oesophageal varices are continuous with oesophageal varices: GOV1 run along the lesser curve (the commonest type and lowest bleeding risk), GOV2 extend into the fundus. Isolated gastric varices have no oesophageal varices: IGV1 are isolated fundal varices (the highest bleeding risk), IGV2 are ectopic varices in the body, antrum or duodenum. GOV2 and IGV1 together are the 'cardiofundal' varices, which bleed more often and more severely. The classification is descriptive, not a score, and it drives management — fundal varices are treated with cyanoacrylate glue, BRTO or TIPS rather than band ligation, and isolated fundal varices must prompt a search for splenic vein thrombosis.

On this page

  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Interpreting the result

Let the type set both the risk and the plan. GOV1, the lesser-curve extension, is the commonest and least dangerous, and is frequently managed as an oesophageal varix with band ligation and non-selective beta-blockade. GOV2 and IGV1 are the cardiofundal varices: they bleed more often and more heavily, and endoscopic cyanoacrylate (glue) injection, balloon-occluded retrograde transvenous obliteration (BRTO) or transjugular intrahepatic portosystemic shunt (TIPS) are the mainstays rather than band ligation. IGV1 in particular is the highest-risk type and demands a deliberate search for splenic vein thrombosis, because isolated fundal varices can be its presenting sign and splenectomy is curative in that setting. IGV2 is rare and managed according to its site.

ScoreBandWhat it meansAction
GOV1Lesser-curve gastro-oesophageal varicesLowest bleeding risk; commonest type (~75%)Often managed as oesophageal varices — band ligation + non-selective beta-blocker
GOV2Fundal gastro-oesophageal varices (cardiofundal)Higher bleeding risk than GOV1Cyanoacrylate glue injection first-line; consider BRTO or TIPS
IGV1Isolated fundal varicesHighest bleeding risk of the four typesGlue, BRTO or TIPS; exclude splenic vein thrombosis
IGV2Isolated ectopic varicesVariable; uncommonSite-dependent — endoscopic glue, interventional radiology or surgery

What the Sarin Classification needs (4 inputs)

GOV1 — gastro-oesophageal varices type 1
Varices extending from the oesophagus along the lesser curvature of the stomach. The most common type (about three-quarters of gastric varices) and the lowest bleeding risk; behave as an extension of oesophageal varices.
GOV2 — gastro-oesophageal varices type 2
Varices extending from the oesophagus into the fundus. A cardiofundal varix, with a higher bleeding risk than GOV1.
IGV1 — isolated gastric varices type 1
Isolated fundal varices with no oesophageal varices. The highest bleeding risk of the four types; their presence should prompt a search for splenic vein thrombosis.
IGV2 — isolated gastric varices type 2
Isolated varices at ectopic sites — gastric body, antrum, pylorus or around the duodenum — with no oesophageal varices. Uncommon.

What it returns

Sarin type
One of GOV1, GOV2, IGV1 or IGV2, assigned from the location seen at endoscopy.
Bleeding-risk and management implication
Cardiofundal varices (GOV2, IGV1) carry the higher risk and call for glue, BRTO or TIPS; GOV1 is often treated like an oesophageal varix.

How it is calculated

Sarin is a two-axis lookup rather than a calculation. The first axis is whether the gastric varices are continuous with oesophageal varices (gastro-oesophageal, GOV) or isolated (IGV); the second is location (lesser curve versus fundus for GOV, fundus versus ectopic for IGV). Those two facts define the four types, and each type carries an empirically observed bleeding risk and a corresponding treatment. The scheme was derived from a large long-term follow-up of portal-hypertension patients, in which fundal (cardiofundal) varices bled more frequently and more severely than lesser-curve varices, which is why the classification maps so cleanly onto management.

Facts & figures

The four Sarin types
TypeLocationOesophageal varices?Relative bleeding risk
GOV1Lesser curve, from oesophagusContinuousLower
GOV2Fundus, from oesophagusContinuousHigher (cardiofundal)
IGV1Fundus, isolatedAbsentHighest
IGV2Body / antrum / pylorus / duodenumAbsentVariable (ectopic)

GOV2 and IGV1 are the cardiofundal varices; IGV1 carries the highest bleeding risk and mandates exclusion of splenic vein thrombosis.

Evidence

Derivation — long-term portal-hypertension cohort

1992 · n = 568

Sarin and colleagues followed 568 patients with portal hypertension over the long term, describing the prevalence, anatomical classification and natural history of gastric varices and relating each type to its bleeding behaviour.

Gastric varices were present in about a fifth of patients. Fundal (cardiofundal) varices bled more frequently and more severely than lesser-curve varices, establishing the risk gradient that the classification encodes; isolated fundal varices carried the highest bleeding incidence.

Risk factors for fundal variceal haemorrhage

1997

Cohort study of patients with gastric fundal varices examining the predictors of bleeding, including variceal size, the presence of red signs and the degree of hepatic dysfunction.

Confirmed that fundal varices are a distinct, higher-risk entity and that bleeding risk rises with variceal size, red colour signs and worse liver function — refining, rather than overturning, the Sarin risk ordering.

How it compares

Sarin Classification vs EVendo Score

They address different moments: EVendo predicts, before endoscopy, whether varices needing treatment are likely to be present; Sarin classifies gastric varices already seen so as to guide treatment.

EVendo is a non-invasive screening score aimed at deciding who needs a screening endoscopy for oesophageal varices. Sarin comes into play once endoscopy has been done and gastric varices are found, and its purpose is anatomical and therapeutic rather than predictive. One helps you decide whether to look; the other helps you decide what to do with what you find.

Open the EVendo Score calculator →

Sarin Classification vs Oesophageal varix size grading (small vs large)

Oesophageal varices are stratified mainly by size and red signs, whereas gastric varices are stratified by location using Sarin — because for gastric varices location, not size, is the dominant driver of both risk and treatment.

For oesophageal varices, size (small versus large or medium/large) plus red wale signs and liver function drive prophylaxis and treatment. That framework does not transfer to gastric varices, where a fundal location signals both higher risk and a need for glue or shunting. Using an oesophageal size framework on a fundal gastric varix is a classic mismatch that the Sarin classification exists to prevent.

Pearls & pitfalls

  • Isolated fundal varices (IGV1) mandate a search for splenic vein thrombosis — it can be the presenting sign, and splenectomy is curative when it is the cause.
  • Do not band-ligate true fundal varices (GOV2, IGV1): ligation is unreliable there and can provoke severe bleeding; cyanoacrylate glue, BRTO or TIPS are the appropriate options.
  • GOV1 is the exception that is often treated like an oesophageal varix, because it shares the oesophageal drainage.
  • Gastric varices can bleed at lower portal pressures than oesophageal varices, so a lower HVPG or a modest-looking varix does not exclude significant bleeding risk.
  • Bleeding risk within a type still rises with variceal size, red signs and worse liver function — the classification sets the baseline, not the whole picture.
  • The type is an endoscopic judgement about location and continuity; cross-sectional imaging of the portal and splenic anatomy often clarifies borderline cases.

Critical actions

  • Record the Sarin type explicitly in the endoscopy report, not just 'gastric varices', so the management plan follows from it.
  • For a bleeding fundal varix (GOV2 or IGV1), use cyanoacrylate glue injection first-line and involve interventional radiology early for BRTO or TIPS.
  • In any isolated fundal varix (IGV1), image the splenic and portal veins to exclude splenic vein thrombosis.
  • Manage GOV1 largely as an oesophageal varix — band ligation and a non-selective beta-blocker for prophylaxis — while confirming it is truly a lesser-curve extension.
  • Resuscitate, give vasoactive drugs and antibiotics for any acute variceal bleed per portal-hypertension guidelines, regardless of the Sarin type.

Why this score exists

Sarin's insight was that gastric varices are not one thing. By separating varices that are continuous with oesophageal varices from those that are isolated, and by distinguishing lesser-curve from fundal location, the classification captured the two facts that actually predict behaviour: whether the varix shares the oesophageal drainage and whether it sits in the high-risk fundus. That the scheme also sorts patients by underlying cause — isolated fundal varices pointing to splenic vein thrombosis — was a further payoff of classifying by anatomy rather than by size alone.

About the creator

  • Shiv K. Sarin

    First author, 1992 classification

    Published the classification of gastric varices by anatomical location that still guides management, and has led much of the subsequent portal-hypertension literature.

Limitations

  • It is a descriptive anatomical classification, not a quantitative risk score, and does not by itself output a bleeding probability.
  • Assigning the type is an endoscopic judgement, and distinguishing a large GOV2 from an IGV1, or a fundal from a cardial varix, can be subjective.
  • Bleeding risk within each type still depends on size, red signs and hepatic reserve, which the classification does not capture.
  • It classifies varices but does not dictate a single treatment; the choice between glue, BRTO and TIPS depends on anatomy, shunt physiology and local expertise.
  • It says nothing about whether varices are present in the first place, so it is not a screening tool.

If you are the patient

Gastric varices are swollen veins in the stomach wall that can form when blood pressure in the liver's circulation is high, usually from cirrhosis. The Sarin classification is the way doctors describe exactly where these veins are, because location tells them how likely the veins are to bleed and how best to treat them. Veins high up in the stomach (the fundus) tend to be riskier and are usually treated by injecting a special medical 'glue' or by a radiology procedure that reroutes blood flow, rather than by the banding used for veins in the gullet. Veins found on their own high in the stomach also prompt a check for a blocked vein near the spleen, which can be the cause and is sometimes curable with an operation. Knowing the exact type helps your team choose the right treatment and the right extra tests.

Frequently asked questions

What is the Sarin classification of gastric varices?#

It is an endoscopic classification that groups gastric varices by location into four types: GOV1 (lesser curve, continuous with oesophageal varices), GOV2 (fundus, continuous with oesophageal varices), IGV1 (isolated fundal varices) and IGV2 (isolated ectopic varices). The type predicts bleeding risk and guides treatment.

Which Sarin type has the highest bleeding risk?#

IGV1 — isolated fundal varices — carries the highest bleeding risk. Together with GOV2 it makes up the 'cardiofundal' varices, which bleed more often and more severely than the lesser-curve GOV1 type.

How are gastric varices treated according to Sarin type?#

GOV1 is often managed like an oesophageal varix with band ligation and a non-selective beta-blocker. Fundal varices (GOV2 and IGV1) are treated with endoscopic cyanoacrylate glue injection, BRTO or TIPS rather than banding. IGV2 is managed according to its site.

Why do isolated fundal varices need a search for splenic vein thrombosis?#

Because isolated fundal gastric varices (IGV1) can be the presenting sign of splenic vein thrombosis, which causes a localised (left-sided) portal hypertension. In that situation splenectomy is curative, so identifying it changes management entirely.

What is the difference between GOV and IGV?#

GOV (gastro-oesophageal varices) are continuous with oesophageal varices and share their drainage; IGV (isolated gastric varices) occur without oesophageal varices. The distinction matters because it reflects different venous anatomy and different bleeding behaviour and treatment.

Is the Sarin classification a bleeding risk score?#

Not exactly — it is a descriptive anatomical classification. It stratifies bleeding risk by location (fundal varices being higher risk) and directs treatment, but it does not output a numerical bleeding probability, and risk within each type still depends on variceal size, red signs and liver function.

Related calculators

  • EVendo Score — Predicts oesophageal varices needing treatment
  • Child-Pugh Score — Assesses the prognosis of chronic liver disease, mainly cirrhosis
  • MELD-Na — Assesses the severity of chronic liver disease
  • Baveno VII Criteria — cACLD, CSPH and sparing screening endoscopy

References

Original / primary reference

  1. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343-1349.

Validation and evidence

  1. Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25(2):307-312.
  2. Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175-1189.

Clinical practice guidelines

  1. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974.
  2. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65(1):310-335.

Further reading

  1. Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54(11):1094-1120.

Last updated July 30, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.