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Updated: Jan 6, 2026
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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
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EUS-Guided Liver Biopsy and Portal Pressure Measurement Compared With a Transjugular Approach: A Randomized
Amine Benmassaoud1, Ali Bessissow2, Gordan Samoukovic3
1Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada.
Summary
Endoscopic ultrasound (EUS) provides superior simultaneous evaluation of liver fibrosis and portal hypertension compared to the transjugular (TJ) technique. EUS-guided procedures yield higher quality liver biopsies and more reliable pressure measurements for diagnosing chronic liver diseases.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Imaging
Background:
- Transjugular (TJ) liver biopsy (LB) and hepatic venous pressure gradient (HVPG) measurement are standard for evaluating portal hypertension and liver fibrosis.
- However, TJ techniques face challenges with HVPG access and LB quality.
- Endoscopic ultrasound (EUS) offers a novel approach for simultaneous portal pressure gradient (PPG) and LB acquisition.
Purpose of the Study:
- To compare the efficacy of EUS-guided PPG LB with TJ HVPG LB for evaluating chronic liver diseases.
- To assess the combined adequacy of LB and reliability of pressure measurements between the two techniques.
Main Methods:
- A randomized trial comparing EUS-guided PPG LB and TJ HVPG LB in patients with chronic liver disease.
- Primary endpoint: combination of adequate LB (≥25 mm length, ≥11 portal tracts) and reliable PPG/HVPG (≤1 mm Hg difference).
- Secondary endpoints included technical success, LB quality, PPG/HVPG reliability, patient satisfaction, and adverse events.
Main Results:
- EUS demonstrated a significantly higher rate of combined adequate LB and reliable PPG (82.8%) compared to TJ (41.4%).
- EUS also showed superior proportions of adequate LB (93.1% vs. 41.4%) and reliable PPG (89.7% vs. 58.6%).
- Technical success rates were comparable (90.0% for EUS vs. 96.6% for TJ), with no significant difference in adverse events.
Conclusions:
- EUS is superior to the TJ technique for the simultaneous acquisition of adequate liver biopsies and reliable portal pressure measurements.
- EUS-guided procedures represent a significant advancement in the evaluation of chronic liver diseases, offering improved diagnostic yield.
