Pathophysiological management of gastric varices: From hemodynamics to targeted therapies

Table 2 Differentiation of efferent/shunt-dominant or afferent/inflow-dominant varices based on various features

Parameter	Efferent (shunt)-dominant varices	Afferent (inflow)-dominant varices
Primary driver	Low-resistance outflow (drain-driven)	High inflow (supply-driven)
Key imaging feature (CT/MR)	Large single shunt (e.g., gastrorenal/gastrocaval)	Multiple feeders, no dominant shunt
Collateral pattern	Limited collaterals, dominant drainage pathway	Dense collateral network
EUS findings	Prominent draining channel, rapid flow toward the shunt	Multiple perforators/feeding vessels, complex flow
Flow dynamics	High-flow toward systemic circulation	Multidirectional or inflow-heavy flow
Portal hypertension features	Less prominent	Marked (ascites, collaterals)
Clinical clues	HE, preserved liver function	Ascites, decompensation, less HE

EUS: Endoscopic ultrasound; CT: Computed tomography; MR: Magnetic resonance; HE: Hepatic encephalopathy.