EUS-Guided Liver Biopsy and Portal Pressure Measurement Compared With a Transjugular Approach: A Randomized...

The transjugular (TJ) technique is recommended for the simultaneous evaluation of portal hypertension and hepatic fibrosis, with the hepatic venous pressure gradient (HVPG) and liver biopsy (LB), respectively. Unfortunately, technical challenges have restricted access to HVPG, and TJ LB is often of suboptimal quality. Endoscopic ultrasound (EUS) is a novel approach capable of obtaining portal pressure gradient (PPG) and LB. Our aim was to compare EUS-guided PPG LB with TJ HVPG LB.

Patients with chronic liver disease simultaneously evaluated for portal hypertension and liver fibrosis at the McGill University Health Centre were randomly assigned to EUS-guided PPG LB or TJ HVPG LB. The primary endpoint was the combination of adequate LB (guideline recommendation: ≥25 mm total length and ≥11 complete portal tracts) and reliable HVPG/PPG (expert consensus: 2 measures within ≤1 mm Hg). Secondary endpoints assessed technical success, LB quality, HVPG/PPG reliability, patient satisfaction, and adverse events. Intention-to-treat analyses were conducted.

Fifty-eight patients were randomized; 29 were EUS and 29 were TJ. Technical success was 90.0% for EUS and 96.6% for TJ (relative risk [RR], 0.93; 95% confidence interval [CI], 0.81-1.07). Combined adequate LB and reliable HVPG/PPG was 82.8% for EUS and 41.4% for TJ (RR, 2.00; 95% CI, 1.26-3.18). Proportion of adequate LB was 93.1% for EUS and 41.4% for TJ (RR, 2.25; 95% CI, 1.44-3.51). Proportion of reliable HVPG/PPG was 89.7% for EUS and 58.6% for TJ (RR, 1.53; 95% CI, 1.10-2.13).We found no between-group difference in adverse events.

EUS is superior to TJ for simultaneous acquisition of adequate LB and reliable PPG, suggesting that it has an important role in evaluating chronic liver diseases.

gov, Number: NCT05118308.