EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study

Abstract

Background & Aims Portal hypertension (PH) is a serious complication of liver cirrhosis. The hepatic venous pressure gradient or portal pressure gradient (PPG) accurately reflects the degree of PH and is the single best prognostic indicator in liver disease. This is usually obtained by interventional radiology (IR) although it is not routinely performed. Recently, we developed a simple novel technique for Endoscopic Ultrasound (EUS)-guided PPG measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and IR-PPGM. We now present the first human pilot study of EUS-PPGM in patients with liver disease. Methods EUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25G FNA-needle and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted via a transgastric/transduodenal approach. Clinical parameters of PH were evaluated in each patient. Feasibility was defined as successful PPGM in each patient. Safety was based on complications captured via post-procedural interview. Results 28 patients underwent EUS-PPGM with 100% technical success and no complications. PPG ranged from 1.5–19mmHg and had excellent correlation with clinical parameters of portal hypertension including the presence of varices (p=0.0002), PH gastropathy (p=0.007) and thrombocytopenia (p=0.036). PPG was increased in patients with high clinical evidence of cirrhosis (p=0.005). Conclusion This novel technique of EUS-PPGM using a 25G needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease

Role of Endoscopic Ultrasound to Assess and Manage Portal Hypertension

“…In a recent pilot study, the PVPG was measured using a 25-G needle in 28 patients without any complications. 71 The time to measure PVPG per patient was short, at < 30 minutes. PVPG measurement correlated well with both endoscopic and clinical parameters such as high risk versus low risk for cirrhosis, variceal bleeding, and portal hypertensive gastropathy.…”

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review

“…3). 61 The study involved 28 patients with a history of liver disease or suspected cirrhosis who also underwent esophagogastroduodenoscopy during the same examination. The transhepatic access route was either transgastric or transduodenal.…”

“…Moreover, PVP gradient was increased in patients with high clinical evidence of cirrhosis (p ¼ 0.05). 61 All these results prompted the authors to conclude that EUS-guided PVP measurement, although at present experimental and not as simple to perform, may have a pivotal role in the management of patients with liver disease. 61…”

Endoscopic ultrasound and the liver: current applications and beyond

“…In the first human pilot study, Huang et al. reported a 100% technical success in 28 patients who underwent both portal vein and hepatic vein measurement with no adverse events reported . This was performed using a 25G FNA needle and compact manometer with non‐compressible tubing.…”