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

Endoscopic ultrasound guided portosystemic pressure gradient (EUS-PPG) measurement is an increasingly utilized technique that allows for direct measurement of hepatic and portal venous pressures. However, practice variability exists with this novel technique. Using the modified Delphi process, we aimed to establish consensus among international experts regarding best practices and future research for EUS-PPG.

A steering committee developed consensus statements covering 4 domains: indications, pre-procedural protocol, intra-procedural technique, and future research. Forty-seven experts (29 advanced endoscopists, 18 hepatologists) were invited to participate via an online survey platform. Consensus for each statement was determined by ≥70% agreement on a Likert scale among participants. Statements that did not reach consensus were modified based on feedback and brought for a re-vote.

A total of 53 statements achieved consensus after 2 rounds. Thirty-seven experts (79% of those invited) participated in both rounds. Notable areas of consensus included the following: (1) Clinical indications for EUS-PPG include all indications for hepatic venous pressure gradient and may be preferred in suspected presinusoidal portal hypertension or when another indication for endoscopy is present (eg, variceal screening); (2) EUS-PPG is safe and well tolerated; (3) EUS-PPG should be performed under monitored anesthesia care or general anesthesia; and (4) meticulous attention to technical details is required to maximize accuracy. New research frontiers for EUS-PPG were identified.

The results of this modified Delphi process established expert agreement on multiple important issues and provided practical guidance on key aspects of EUS-PPG. This document could provide a roadmap for future research studies.