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Deplano, Alessandro; Migaleddu, Vincenzo; Pischedda, A.; Garrucciu, Giovanni; Gregu, G.; Multinu, C; Piredda, Maria Liliana; Tocco, A.; Urigo, F; Cossu, P; Solinas, Antonio

doi:10.1023/a:1026622721389

Cited by 27 publications

(6 citation statements)

References 22 publications

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“…This procedure requires no iodinated contrast or ionizing radiation and is well tolerated by patients, recovering in a similar manner to routine gastroscopy. Furthermore, direct portal pressure measurement is likely to be more accurate than the indirect WHVP, particularly in non-alcoholic cirrhosis or primary biliary cirrhosis 16–19 .…”

Section: Discussionmentioning

confidence: 99%

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

Huang

Samarasena

Tsujino

et al. 2017

Gastrointestinal Endoscopy

127

102

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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

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Section: Discussionmentioning

confidence: 99%

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

Huang

Samarasena

Tsujino

et al. 2017

Gastrointestinal Endoscopy

127

102

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“…5 However, HVPG can be affected by hepatic tissue compliance and other factors. 6 Recently, our group developed a simple novel technique for EUS-guided PPG measurement (EUS-PPG) and demonstrated its accuracy and performance in an animal study and an initial human pilot study. 7,8 Endoscopic ultrasound-guided liver biopsy (EUSbx) has also been shown to be a safe and effective technique for the diagnosis of acute and chronic liver diseases.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound‐guided portal pressure gradient with liver biopsy: 6 years of endo‐hepatology in practice

Choi¹,

Kolb²,

Shah

et al. 2022

J of Gastro and Hepatol

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Background and Aim The portal pressure gradient (PPG) is a useful predictor of portal hypertension (PH) related complications. We previously showed the feasibility and safety of endoscopic ultrasound guided PPG measurement (EUS‐PPG). Now EUS‐guided liver biopsy (EUS‐bx) has been shown to be a safe and effective alternative to percutaneous or Interventional Radiology‐guided liver biopsy for the diagnosis of chronic liver disease (CLD). We aimed to evaluate the correlation between PPG and clinical markers of PH, and assess the feasibility and safety of concomitant, single session EUS‐PPG and EUS‐bx. Methods This was a retrospective study of patients undergoing EUS‐PPG for CLD at a single tertiary endoscopy center between February 2014 and March 2020. EUS‐PPG was performed using a 25‐gauge needle and compact manometer. Data analysis was performed with SAS version 9.4. Results Eighty‐three patients underwent EUS‐PPG with 100% technical success. The mean PPG was 7.06 mmHg (SD 6.09, range 0–27.3). PPG was higher in patients with (vs without) clinical features of cirrhosis (9.46 vs 3.61 mmHg, P < 0.0001), esophageal or gastric varices (13.88 vs 4.34 mmHg, P < 0.0001), and thrombocytopenia (9.25 vs 4.71 mmHg, P = 0.0022). In the 71 patients (85.5%) who underwent EUS‐bx, 70 (98.6%) specimens were deemed adequate by the pathologist for histologic diagnosis. There were no early or late major adverse events. Conclusion EUS‐PPG correlates well with clinical markers of PH. EUS‐bx can be performed safely during the same session as EUS‐PPG, providing a comprehensive endoscopic evaluation of the patient with CLD.

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“…In general, WHVP measurements appear to slightly underestimate PP in viral- or alcohol-related cirrhosis, but the difference is small (1.3 mmHg), possibly due to the umbilical vein opening, portal anastomotic branch, gastric shunt, or the presence of tiny hepatic venous-to-venous communication branches that were not detected or reversed liver blood flow, etc. [ 15 , 18 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Agreement between Wedged Hepatic Venous Pressure and Portal Pressure in Hepatic Sinusoidal Obstruction Syndrome

Cheng

Gu²,

Yin³

et al. 2022

JPM

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Background: Wedge hepatic vein pressure (WHVP) accurately estimates the portal pressure (PP) in chronic sinusoidal portal hypertension patients. Whether this applies to patients with acute portal hypertension due to hepatic sinusoidal obstruction syndrome (HSOS) is unclear. Our aim was to assess the agreement between WHVP and PP in patients with HSOS by comparing them to decompensated cirrhosis patients. Methods: From December 2013 to December 2021, patients with pyrrolidine alkaloid-induced HSOS (PA-HSOS) receiving hepatic venous pressure gradient (HVPG) measurement and transjugular intrahepatic portosystem shunt (TIPS) were retrospectively collected and matched with those of patients with virus- or alcohol-related cirrhosis as a cirrhosis group. Pearson’s correlation (R), intraclass correlation coefficient (ICC), scatter plots, and the Bland–Altman method were performed for agreement evaluation. Results: A total of 64 patients were analyzed (30 PA-HSOS and 34 cirrhosis groups). The correlation between WHVP and PP was moderate in the PA-HSOS group (R: 0.58, p = 0.001; ICC: 0.68, p = 0.002) but good in the cirrhosis group (R: 0.81, p < 0.001; ICC: 0.90, p < 0.001). The percentage of patients with inconsistent WHVP and PP in the two groups was 13 (43.3%) and 15 (26.5%) (p = 0.156), respectively, and an overestimation of PP was more common in the PA-HSOS group (33.3% vs. 2.9%, p = 0.004). HVPG and portal pressure gradient (PPG) consistency was poor in both groups (R: 0.51 vs. 0.26; ICC: 0.65 vs. 0.41; p < 0.05). Conclusions: WHVP in patients with PA-HSOS did not estimate PP as accurately as in patients with virus- or alcohol-related cirrhosis, which was mainly due to PP overestimation.

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Cited by 27 publications

References 22 publications

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

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

Endoscopic ultrasound‐guided portal pressure gradient with liver biopsy: 6 years of endo‐hepatology in practice

Agreement between Wedged Hepatic Venous Pressure and Portal Pressure in Hepatic Sinusoidal Obstruction Syndrome

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