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Endoscopic Classification of Esophageal Varices and its Clinical Significance Y. Kumagai 1 , H. Makuuchi 1 , T. Tsuzuki 2 1Department of Endoscopy, Keio Cancer Detective Center 2Department of Surgery, Medical School of Keio University pp.741-750
Published Date 1976/6/25
DOI https://doi.org/10.11477/mf.1403107290
  • Abstract
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 Esophageal varices are classified into 3 grades on the ground of fiberscopic examinations performed on 117 patients, with 263 repeated examinations.

 Grade 1 is characterized by dilated submucosal veins, which do not bulge into the esophageal lumen.

 Grade 2 is observed as semispherical protuberance of submucosal varices with smooth surface into the esophageal lumen.

 Grade 3 is presented as protuberance of dilated tortuous varices with superimposed varices into the esophageal lumen, which are similar to varices on top of varices designated by Dagradi, close correlation observed between the frequency of bleeding and the grade of the esophageal varices. None bled in grade 1 and 6 out of 29 patients classified into grade 2 experienced hemorrhage, indicating the frequency of 20 percent, while 32 out of 50 patients of grade 3 bled with a frequency of 64 percent. There were 6 bleeding cases classified into Grade 2 ; 2 were due to gastric bleeding, the other 2 had esophageal erosion due to reflux esophagitis and 1 had marked ascites, which also tends to cause reflux esophagitis.

 These observations led as to conclude that patients of grade 3 are very liable to bleed and they should be undergone esophageal transection even if they have not experienced hemorrhage before. And it is also suggested that grade 2 varices with reflex esophagitis is an indication for esophageal transection, since reflex esophagitis is a precipitating factor in variceal bleeding.


Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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