International Expert Delphi Consensus on Endoscopic Ultrasound-guided Portosystemic Pressure Gradient: Best Practices...

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Hepatology

Background:

• Endoscopic ultrasound-guided portosystemic pressure gradient (EUS-PPG) measurement is a novel technique for assessing hepatic and portal venous pressures.
• Variability in practice exists for this emerging procedure.
• Establishing consensus on best practices is crucial for its widespread adoption and accurate application.

Purpose of the Study:

• To establish international expert consensus on best practices for EUS-PPG measurement.
• To define indications, pre-procedural protocols, and intra-procedural techniques for EUS-PPG.
• To identify future research directions for EUS-PPG.

Main Methods:

• A modified Delphi process was employed, involving a steering committee and 47 international experts (advanced endoscopists and hepatologists).
• Consensus statements were developed across four domains: indications, pre-procedural protocol, intra-procedural technique, and future research.
• Statements required ≥70% agreement via online surveys, with revisions and re-votes for non-consensus items.

Main Results:

• 53 statements achieved consensus after two rounds, with 79% expert participation.
• Consensus was reached on clinical indications, including suitability for all hepatic venous pressure gradient (HVPG) indications and potential preference in presinusoidal portal hypertension.
• EUS-PPG was deemed safe, well-tolerated, requiring monitored or general anesthesia, and necessitating meticulous technical execution for accuracy.

Conclusions:

• The modified Delphi process successfully established expert agreement on key aspects of EUS-PPG.
• This consensus provides practical guidance for performing EUS-PPG.
• The findings serve as a roadmap for future research in EUS-PPG.