A prospective study of the ability of three endoscopic classifications to predict hemorrhage from esophageal varices

Gastrointest Endosc. Jul-Aug 1992;38(4):425-9. doi: 10.1016/s0016-5107(92)70470-2.


Hemorrhage from esophageal varices in cirrhotics is a frequent event with high mortality in spite of therapy. Preventive sclerotherapy seems to be beneficial only if the patient's bleeding risk is higher than 40 to 50% a year. A series of 320 patients with esophageal varices without previous bleeding was studied prospectively; the varices were classified according to three widely used endoscopic classifications. During follow-up (6 to 36 months, average 14 months), hemorrhage occurred in 49 patients (15.3%) of whom 30 (61.2%) bled from varices (8.2 and 11.0% at 12 and 24 months, respectively). At the same time intervals, mortality of the entire population studied was 18.0 and 23.8%, respectively, of which one third was directly due to hemorrhage. With all three classifications, the higher the degree of bleeding risk, the greater the actual percentage of hemorrhages recorded; however, it never reached 40% a year. In predicting the bleeding event, Dagradi's classification proved more sensitive than JRSPH or NIEC, but the latter classifications were more specific and assessed a higher predictive value for a positive test. Endoscopic observation probably needs integration with other methods if a reliable bleeding prediction is to be made.

MeSH terms

  • Esophageal and Gastric Varices / classification
  • Esophageal and Gastric Varices / diagnosis
  • Esophageal and Gastric Varices / epidemiology*
  • Esophagoscopy*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / epidemiology*
  • Humans
  • Incidence
  • Life Tables
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors