Endoscopic Ultrasound-Guided Portosystemic Pressure Gradient Correlates With Clinical Parameters and Liver Histology

Area of Science:

• Gastroenterology
• Hepatology
• Medical Imaging

Background:

• Portal hypertension (PH) is a critical condition impacting liver disease prognosis and treatment.
• Endoscopic ultrasound-guided portosystemic pressure gradient measurement (EUS-PPG) is an emerging technique for PH evaluation.

Purpose of the Study:

• To assess the safety and efficacy of EUS-PPG.
• To evaluate the correlation of EUS-PPG with clinical parameters and liver histology.
• To determine EUS-PPG's predictive value for cirrhosis.

Main Methods:

• A multicenter, retrospective study involving 385 patients undergoing EUS-PPG.
• Analysis of EUS-PPG correlation with clinical PH indicators, liver biopsy results, and noninvasive fibrosis markers (Fibrosis-4, APRI).
• Logistic regression to identify the best predictor of histologic cirrhosis.

Main Results:

• High technical success rate (97%) with EUS-PPG in 373 patients.
• Significantly higher PPGs in patients with esophageal varices, portal hypertensive gastropathy, and thrombocytopenia (P < .001).
• EUS-PPG demonstrated superior prediction of cirrhosis (AUC 0.84) compared to Fibrosis-4 (0.72) and APRI (0.54).
• Only 2 minor adverse events (postprocedural pain) were reported.

Conclusions:

• EUS-PPG is a technically feasible and safe procedure for measuring portosystemic pressure gradients.
• EUS-PPG shows strong correlation with clinical signs of PH and liver histology.
• EUS-PPG, particularly >5 mm Hg, is a superior predictor of cirrhosis compared to noninvasive fibrosis markers.