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Updated: Jul 9, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Comparison of left lateral and supine positioning for endoscopic ultrasound-guided portal pressure gradient
Zhao Lei1, Shaobin Luo1, Huanyuan Lu1
1Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
Background And Aims:
EUS-guided portal pressure gradient (EUS-PPG) measurement is typically performed with the patient in the supine position, whereas the left lateral position is standard for routine EUS. This study aimed to compare EUS-PPG measurements obtained in the left lateral and supine positions.
Methods:
In this prospective, single-center study, patients with portal hypertension underwent EUS-PPG measurement under moderate sedation. Portal vein and hepatic vein pressures were measured sequentially in both positions without repeat puncture. PPG was calculated as mean portal vein minus mean hepatic venous pressure. Feasibility and adverse events were recorded.
Results:
Of 35 screened patients, 31 consented and 29 completed measurements in both positions; in 2 patients, supine measurements could not be completed because coughing during repositioning dislodged the needle. In the 29 analyzed patients, portal vein pressure and hepatic venous pressure were lower in the left lateral than in the supine position (both P < .0001). PPG was 17.2 ± 7.4 mm Hg in the supine position and 16.7 ± 6.9 mm Hg in the left lateral position (P = .136). PPG values showed a strong correlation between positions (r = 0.978; P < .0001) and good agreement on Bland-Altman analysis. Fewer coughing events were observed in the left lateral position.
Conclusions:
PPG measurements were consistent between the left lateral and supine positions. When the patient was under moderate sedation, the left lateral position was associated with fewer coughing events and may improve procedural safety and convenience.
