Head-to-head comparison of endoscopic ultrasound and transjugular portal pressure measurements

Aims Endoscopic ultrasound (EUS) has emerged as a new tool in assessing portal hypertension (PH). EUS portal pressure gradient (EUS-PPG) was described in few studies using a compact manometer, but the use of a pressure transducer connected to a pressure measurement monitor was previously described in a very small number of patients. The comparative assessment of portal pressure gradient measured by EUS and tranjugular route has not been done before. Our study aimed to compare the values of EUS-PPG and transjugular measurements (hepatic vein pressure gradient – HVPG, PPG) in patients with portal hypertension.

Methods Patients with signs of PH on transabdominal imaging and need for haemodynamic and/or endoscopic assessment were included. Patients with platelet count<50000/µL and INR>2.5 were excluded. EUS was performed using a 22 G fine needle aspiration attached to a central venous pressure measurement monitor, and it evaluated the presence of gastrointestinal varices, portal vein (PV) diameter and pressure, median hepatic vein/inferior vena cava pressure. All patients had HVPG measurements through the transjugular approach under fluoroscopic guidance, and portal pressure was assessed in patients scheduled for portosystemic shunt (TIPS). The results obtained by the two methods were statistically analysed

Results We prospectively enrolled (January to November 2023) 19 patients of 50±14 years old, male to female ratio=2,1:1. The etiology of PH was porto-sinusoidal vascular disease (n=2, 10%), Budd-Chiari (n=1, 5%), alcohol cirrhosis (n=15, 75%), viral cirrhosis (n=1, 5%) and metabolic cirrhosis (n=1, 5). The mean INR was 1.41 and the mean platelet level was 122.000/ µL. EUS-PPG was technically successful in 18 patients (94%), with one failure attributed to obesity and significant ascites, which limited the needle&apos;s deep advancement. The mean EUS-PPG was 13.6±5.48 mmHg. 73% of patients had oesophageal and/or gastric varices present. The mean PV diameter was 12.7±2.7 mm. HVPG measurements were technically performed in 18 cases (94%), the one exception was related to anatomical factors impeding hepatic vein catheterisation. Mean HVPG was 14.7±5.26 mmHg and it was similar to EUS-PPG, with strong Pearson correlation coefficient (r=0.88). In patients scheduled for TIPS (n=10), mean PPG was 16±4,15 mmHg and it correlated with EUS-PPG (r=0,81).No difference was observed between the patients performing measurements during TIPS under general anaesthesia and the group assessed under mild sedation with midazolam. No adverse effects were noted. [1] [2] [3] [4] [5]

Conclusions The measurements of PH by transjugular route or EUS are comparable. EUS-PPG measurement with 22G needle proved to be an accurate and safe technique. Further investigation is required to determine its indications in patients requiring endoscopic assessment of portal hypertension

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024

• References

• 1 Samarasena JB, Chang KJ.. Endoscopic Ultrasound-Guided Interventions for the Measurement and Treatment of Portal Hypertension. Gastrointest Endosc Clin N Am 2019; 29 (02) 311-320
• 2 Huang JY, Samarasena JB, Tsujino T, Lee J, Hu KQ, McLaren CE, Chen WP, Chang KJ.. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc 2017; 85 (05) 996-1001
• 3 Samarasena JB, Chang KJ.. Endoscopic Ultrasound-Guided Portal Pressure Measurement and Interventions. Clin Endosc 2018; 51 (03) 222-228
• 4 Hajifathalian K, Westerveld D, Kaplan A, Dawod E, Herr A, Ianelli M, Saggese A, Kumar S, Fortune BE, Sharaiha RZ.. Simultaneous EUS-guided portosystemic pressure measurement and liver biopsy sampling correlate with clinically meaningful outcomes. Gastrointest Endosc 2022; 95 (04) 703-710
• 5 Zhang W, Peng C, Zhang S, Huang S, Shen S, Xu G, Zhang F, Xiao J, Zhang M, Zhuge Y, Wang L, Zou X, Lv Y.. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension. Gastrointest Endosc 2021; 93 (03) 565-572