EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility

Lai, Lawrence P.; Poneros, John M.; Santilli, John; Brugge, William R.

doi:10.1016/s0016-5107(03)02544-6

Cited by 88 publications

(67 citation statements)

References 13 publications

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“…17 The mean portal pressures measured by EUS-guided and transhepatic catheterization were found to be well correlated under all conditions (r = 0.91). 17 In another study involving 5 pigs, EUS-guided catheterization of intrahepatic portal vein for angiography and pressure measurements using a 19 G needle was shown to be feasible without complication. 18 Recently, the feasibility of rapid EUS-guided needle access and portal pressure measurement using a 22 G needle and a digital pressure wire was demonstrated in porcine model with good correlation with measurement obtained by conventional transjugular catheterization.…”

Section: Eus-guided Assessment Of Portal Hemodynamics and Creation Ofmentioning

confidence: 76%

“…[17][18][19][20][21][22] In 2004, the feasibility of EUS-guided extrahepatic portal vein catheterization and portal pressure measurement using a 22 G needle was first demonstrated in a porcine model involving 7 normal pigs and 14 pigs with induced pHTN. 17 The mean portal pressures measured by EUS-guided and transhepatic catheterization were found to be well correlated under all conditions (r = 0.91). 17 In another study involving 5 pigs, EUS-guided catheterization of intrahepatic portal vein for angiography and pressure measurements using a 19 G needle was shown to be feasible without complication.…”

Section: Eus-guided Assessment Of Portal Hemodynamics and Creation Ofmentioning

confidence: 99%

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Endoscopic ultrasound-guided vascular intervention for portal hypertension

Tang

2017

Int J Gastrointest Interv

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A B S T R A C TAs endoscopic ultrasound (EUS) equipment improves, the diagnostic and therapeutic applications of EUS in patients with portal hypertension (pHTN) have been increasingly explored. Various EUS-guided vascular interventions for pHTN have been evaluated in human or animal studies. EUS has been shown to be useful in variceal and perforating feeding veins identification, prediction of variceal recurrence/rebleeding, and assessment of response to pharmacological therapy for pHTN. When compared to conventional endoscopic therapies, EUS-guided therapy for varices and/or perforating feeding veins can ensure intra-variceal delivery of injection therapy, allow real-time monitoring of variceal obliteration, and provide injection therapy under pure EUS guidance when the target varix is endoscopically obscured. While the feasibility of EUS-guided assessment of portal hemodynamics and creation of intrahepatic portosystemic shunt has been evaluated, further studies would be needed to assess the long term outcomes before routine application.

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Section: Eus-guided Assessment Of Portal Hemodynamics and Creation Ofmentioning

confidence: 76%

Section: Eus-guided Assessment Of Portal Hemodynamics and Creation Ofmentioning

confidence: 99%

Endoscopic ultrasound-guided vascular intervention for portal hypertension

Tang

2017

Int J Gastrointest Interv

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“…evaluated the feasibility and safety of EUS-guided PV angiography in a porcine model with an FNA needle using carbon dioxide (CO2) as a contrast agent, and found this approach to be feasible, technically simple, and safe. Lai et al[7] investigated the feasibility of EUS-guided portal vein catheterization in animals in both a normal and portal hypertension-induced state, and correlated these measurements with those obtained via a transhepatic approach. Pressures were measured using an analog system, where the proximal end of the needle was connected to a fluid-filled manometer and pressure recorder.…”

Section: Discussionmentioning

confidence: 99%

EUS-guided portal pressure measurement using a digital pressure wire with real-time remote display: a novel, minimally invasive technique for direct measurement in an animal model

Schulman

Thompson

Ryou

2016

Gastrointestinal Endoscopy

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Background and Aims Hepatic venous pressure gradient (HVPG) currently serves as a surrogate for portal pressure measurement but has many limitations. We have developed a novel technique for rapid and direct portal pressure measurements using a digital pressure wire delivered through an EUS-guided 22-G FNA needle. Our aims were to evaluate (1) short term safety and technical feasibility; (2) procedural duration and subjective workload assessment; and (3) accuracy compared with a transjugular criterion standard approach. Methods The subjects were Yorkshire pigs, weighing 40 to 55 kg. The portal vein was identified using a linear-array echoendoscope and accessed with a commercially available 22-G FNA needle preloaded with a digital pressure wire. Access was confirmed by portal venography. Mean digital pressure measurements were recorded over 30 to 60 seconds and the NASA task load index (TLI) was scored. The control measurements were conventional transjugular catheterization with a balloon occlusion catheter to obtain free and wedged hepatic pressures, with subsequent HVPG calculation. Results The total time required for EUS identification and needle access of portal vein, venography, and digital pressure measurement was less than 5 minutes in 5 out of 5 pigs. The NASA TLI scores revealed a low subjective workload. Baseline portal pressure measurements via EUS ranged from 5 to 10 mm Hg (mean 6.4). HVPG measurements were consistently +/−1 mm Hg of portal pressure. Conclusions This study represents the first report of direct EUS-guided portal pressure measurements using a digital pressure wire. This method is routinely performed in minutes and provides real-time pressure tracings via wireless transmission. This novel approach for direct portal pressure measurement has the potential to supplant traditional indirect HVPG measurements.

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“…These experiments were also complicated by intraperitoneal bleeding and hematoma formation at the sites of the PV puncture. 52 Giday and colleagues 53 performed transhepatic PV catheterization with a modified endoscopic retrograde cholangiopancreatography catheter, which allowed them to perform good-quality portal angiography and obtain continuous portal pressure readings over 1 h, with consistent results and minimal variability within each animal. The position of the catheter inside the PV was stable and was not influenced by the animal's respiratory motions or movements of the operator or endoscope.…”

Section: Portal Vein Angiography and Pressure Measurementsmentioning

confidence: 99%