Definition of Upper Abdominal Varices
Upper abdominal varices are dilated portosystemic collateral vessels located in the upper abdomen, including gastric varices, perigastric varices, peripancreatic varices, and other periportal collaterals that develop as a consequence of portal hypertension. 1
Anatomical Classification
The term "upper abdominal varices" encompasses several distinct types of varices based on their location and relationship to other structures:
Gastric Varices
Gastric varices are the most clinically relevant upper abdominal varices and are classified into two main categories 1:
Gastroesophageal Varices (GOV) - Extensions of esophageal varices:
- Type 1 (GOV1): Extend along the lesser curvature of the stomach (most common type)
- Type 2 (GOV2): Extend along the gastric fundus, typically longer and more tortuous
Isolated Gastric Varices (IGV) - Occur without esophageal varices:
- Type 1 (IGV1): Located in the fundus, tend to be tortuous and complex
- Type 2 (IGV2): Located in the gastric body, antrum, or around the pylorus
Other Upper Abdominal Varices
Beyond gastric varices, upper abdominal varices include 2:
- Periesophageal varices: Around the distal esophagus
- Perigastric varices: Surrounding the stomach
- Peripancreatic varices: Around the pancreas
- Pararenal space varices: In the retroperitoneal spaces
- Gallbladder fossa varices: Around the gallbladder
Clinical Significance
Prevalence and Bleeding Risk:
- Gastric varices occur in 5-33% of patients with portal hypertension 1
- Bleeding incidence is approximately 25% over 2 years, with higher rates for fundal varices 1
- Fundal varices (GOV2 and IGV1) carry higher bleeding risk than lesser curve varices (GOV1)
Risk Factors for Hemorrhage 1:
- Size of fundal varices (large ≥10 mm, medium 5-10 mm, small <5 mm)
- Child-Pugh class (C > B > A)
- Presence of red spots (localized reddish areas on variceal surface)
Important Clinical Caveat
When IGV1 fundal varices are identified, splenic vein thrombosis must be excluded 1, as this represents a distinct pathophysiology requiring different management considerations.
Diagnostic Approach
Upper abdominal varices appear on contrast-enhanced CT as lobulated or discrete rounded tubular densities in characteristic perivisceral locations 2. However, esophagogastroduodenoscopy (EGD) remains the gold standard for diagnosis 1, allowing direct visualization, classification, and assessment of bleeding risk features.