BACKGROUND: Clinically significant portal hypertension (GPVH>10mmHg) is a major cause of decompensation and death in patients with liver cirrhosis. Hepatic venous pressure gradient (HVPG) is considered the current gold standard to estimate the portal pressure gradient. Although the possibility of measuring the portal pressure gradient by echoendoscopy (EUS-PPG) has been described, it has not been validated against HVPG.
AIMS: To evaluate the concordance of GPP-EUS with the transjugular measurement of HVPG in patients with established or suspected portal hypertension. Secondary objectives: to evaluate the technical success and safety of EUS-PPG.
METHODS. Prospective double-blind comparative study. Consecutive patients with data of portal hypertension or suspected portal hypertension were enrolled. The included patients underwent EUS-PPG measurement with conventional 22G FNA needle and a transjugular HVPG. Correlation between techniques was assessed with Intraclass correlation coefficient (ICC) and Bland-Altman plot.
RESULTS: 34 patients were included. No significant differences were observed in the success rate between EUS-PPG: 31/34 (91.2%) vs HVPG: 31/33 (93.9%) (p=0.6). Thirty patients with successfully EUS-PPG and HVPG measurements were analysed. The correlation between the two techniques was very good, with an ICC of 0.82. The agreement according to the Bland-Altman plot comparison was good, with only one case (3.33%) outside 1.96 D.S. Four patients had significant discrepancies (≥ 5mmHg between GPVH and GPP-EUS measurement). Only MASLD aetiology versus other aetiologies was significantly associated with the occurrence of significant discrepancies (43% vs 4%, p=0.03). No differences in adverse events were observed between techniques (3%).
CONCLUSIONS: EUS-PPG using a 22-gauge FNA needle is a reliable and safe technique for measuring the portal pressure gradient in cirrhotic patients. EUS-PGG could become the new gold standard as a direct method that correlates well with HVPG.

Endoscopic ultrasound image of needle puncture of the left portal vein with a 22G fine needle aspiration needle.

Endoscopic ultrasound image of needle puncture of the left hepatic vein with a 22G fine needle aspiration needle.

Pablo Bellot

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