Dr. Hector Zapata

06/10/2026

Alliancer Centro Médico de Oncología Avanzada.

30/09/2026

Sarin Classification of Gastric Varices
A Practical Endoscopic Guide to GOV & IGV with Clinical Implications

28/09/2026

VS CLASSIFICATION

Vessel Plus Surface Classification System

Magnifying Endoscopy + NBI for Early Gastric Cancer
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THE CONCEPT

VS = V + S

V → Microvascular Pattern
S → Microsurface Pattern

Assess V and S independently
＋
Look for a Demarcation Line (DL)

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V — MICROVASCULAR PATTERN

🟢 REGULAR — V1

• Uniform vessel shape
• Symmetrical distribution
• Regular arrangement

🔴 IRREGULAR — V2

• Variable / bizarre vessel shape
• Tortuous or branched vessels
• Asymmetrical distribution
• Irregular arrangement

⚪ ABSENT — V0

• Microvascular pattern is not clearly visible
• May be obscured by White Opaque Substance (WOS) or inflammation

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S — MICROSURFACE PATTERN

🟢 REGULAR — S1

• Uniform surface structures
• Symmetrical distribution
• Regular arrangement

🔴 IRREGULAR — S2

• Variable / irregular surface structures
• Asymmetrical distribution
• Irregular arrangement

⚪ ABSENT — S0

• Microsurface pattern is not clearly visible
• May be obscured by inflammation, deposits or WOS
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THE PRACTICAL APPROACH

1 — FIND THE DEMARCATION LINE

Is there a clear boundary between the lesion and surrounding mucosa?

↓

2 — ASSESS V

Regular / Irregular / Absent

↓

3 — ASSESS S

Regular / Irregular / Absent

↓

4 — INTEGRATE

DL + IRREGULAR V AND/OR IRREGULAR S

→ SUSPECT EARLY GASTRIC CANCER

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CLINICAL PEARLS

01 — DL is the key initial finding.
02 — Always assess V and S independently.
03 — Focus on irregularity of vascular and surface patterns.
04 — V0/S0 does not automatically mean normal mucosa.
05 — WOS and inflammation may obscure V/S patterns.
06 — Use high-quality magnifying endoscopy with NBI.
07 — Integrate endoscopic findings with lesion morphology and biopsy when indicated.

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13/09/2026

🟡 BILIARY STENTS

How to Choose the Right Stent?

1️⃣ Plastic Stents

✔️ Cheap and easy to insert/remove
✔️ Best for temporary biliary drainage
✔️ Commonly used in benign strictures and when repeat ERCP is expected

❌ Smaller diameter → shorter patency and higher risk of occlusion

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2️⃣ Uncovered SEMS

✔️ Large diameter and long patency
✔️ Low migration risk

❌ Tumor/tissue ingrowth
❌ Usually difficult to remove

🎯 Best suited for unresectable malignant biliary obstruction requiring long-term palliation.

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3️⃣ Partially Covered SEMS

✔️ A compromise between preventing ingrowth and reducing migration

❌ Tissue ingrowth can still occur at the uncovered ends
❌ Removal may be difficult

🎯 Mainly used in selected cases of malignant biliary obstruction.

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4️⃣ Fully Covered SEMS

✔️ Prevents tissue/tumor ingrowth
✔️ Usually removable
✔️ Longer patency than plastic stents

❌ Higher risk of migration
❌ May obstruct side branches depending on location

🎯 Particularly useful in benign biliary strictures and selected malignant cases where future removal is expected.

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Clinical Take-Home Message

🟢 Need temporary drainage? → Plastic stent

🟢 Benign stricture + need future removal? → Fully covered SEMS

🟢 Unresectable malignant obstruction + long-term palliation? → SEMS

🟢 Always consider the level of obstruction and the anatomy before choosing the stent.

The best biliary stent is not the most expensive one…

07/09/2026

03/09/2026

03/09/2026

✨ Una limpieza dental no es solamente por estética.
La acumulación de placa y sarro puede favorecer inflamación de encías, sangrado y mal aliento. 🦷

Si ya pasó tiempo desde tu última limpieza, este puede ser un buen momento para hacerte una revisión.💙

📩 Envíame mensaje para agendar. 👩🏻‍⚕️ Dra. Sofía Landeros

30/08/2026

La osteoporosis provoca una disminución en la resistencia de los huesos y puede aumentar el riesgo de fracturas.

Su desarrollo puede avanzar durante años sin generar síntomas evidentes, por lo que cuidar la salud ósea no debería comenzar únicamente cuando aparece una lesión.

La actividad física, una alimentación adecuada y la valoración de los factores de riesgo forman parte del cuidado de nuestros huesos a lo largo de la vida.

COFEPRIS: 2505082002A00186
No. de cédula: 3411163 / 2211249
Dr. Manuel Gerardo Ylizaliturri Resce
Ortopedista

30/08/2026