Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis (CHESS1904): An international multicenter study

Abstract

Aim To determine the tolerance and acceptance of hepatic venous pressure gradient (HVPG) measurements in patients with liver cirrhosis. Methods This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020. Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires. Results HVPG measurements were technically successful in all 271 patients, with 141 (52.0%) undergoing HVPG measurement alone. The complication rate was 0.4%. Postoperative pain was significantly lower than preoperative expected pain (p < 0.001) and intraoperative pain (p < 0.001), and intraoperative pain was also significantly lower than preoperative expected pain (p = 0.036). No, mild, moderate, severe, and intolerable discomfort scores were reported by 36.9%, 44.6%, 11.1%, 6.3%, and 0.4% of these patients, respectively, during HVPG measurement and by 54.6% 32.5%, 11.4%, 1.5%, and 0%, respectively, after HVPG measurement. Of these patients, 39.5% had little understanding and 10% had no understanding of the value of HVPG measurement, with 35.1% and 4.1% regarding HVPG measurements as being of little or no help, respectively. Most patients reported that they would definitely (15.5%), probably (46.9%), or possibly (29.9%) choose to undergo additional HVPG measurements again, and 62.7% regarded the cost of the procedure as acceptable. Conclusion HVPG measurement was safe and well‐tolerated in patients with cirrhosis, but patient education and communication are warranted to improve the acceptance of this procedure.

Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma, cirrhosis and portal hypertension treated with hepatectomy

“…38 However, HVPG measurement is not routinely performed in clinical practice because of its invasiveness, high cost, and requirement for operator expertise. 41 In our study, all patients with HCC also had cirrhosis and CSPH, and Spx improved their OS. Moreover, the absence of tumor encapsulation, the presence of MVI, and poor tumor differentiation were found to be independently related to poor long-term survival in these patients.…”

“…HVPG of >10 mmHg is the gold standard for defining CSPH 38 . However, HVPG measurement is not routinely performed in clinical practice because of its invasiveness, high cost, and requirement for operator expertise 41 . In our study, all patients with HCC also had cirrhosis and CSPH, and Spx improved their OS.…”

Hepatic venous pressure gradient (HVPG) measurement: Tips and pitfalls of hepatic venous catheterization

“…In addition, it is effective in differentiating between cirrhosis and IPH. Based on the backgrounds, Sun et al reported well tolerance and the safety of the technique in the recently performed prospective international multicenter study 5 ; the technical success of HVPG measurement in all 271 patients with single HVPG measurement in 52% of them, and the complication rate of 0.4%. As for the tolerance of hepatic venous catheterization, the postoperative pain was significantly less than the preoperative expected pain ( p < 0.001) or the intraoperative pain ( p < 0.001), and the intraoperative pain was also significantly less than the preoperative expected pain ( p = 0.036).…”