EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study

Abstract

Background and aims: Portal hypertension (PH) is a serious adverse event of liver cirrhosis. The hepatic venous pressure gradient or portal pressure gradient (PPG) accurately reflects the degree of PH and is the single best prognostic indicator in liver disease. This is usually obtained by interventional radiology (IR), although it is not routinely performed. Recently, we developed a simple novel technique for EUS-guided PPG measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and IR-PPGM. We present the first human pilot study of EUS-PPGM in patients with liver disease.

Methods: EUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge fine-needle aspiration needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted using a transgastric-transduodenal approach. Clinical parameters of PH were evaluated in each patient. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview.

Results: Twenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19 mm Hg and had excellent correlation with clinical parameters of portal hypertension including the presence of varices (P = .0002), PH gastropathy (P = .007), and thrombocytopenia (P = .036). PPG was increased in patients with high clinical evidence of cirrhosis (P = .005).

Conclusion: This novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease.

Figure 1

Compact manometer

Figure 2

A)Endoscopic Ultrasound Image of transgastric transhepatic needle puncture into the portal vein with a 25G FNA needle B) Diagram representing EUS guided transgastric portal vein puncture.

Figure 3

A) Endoscopic Ultrasound Image of transgastric transhepatic needle puncture into the hepatic vein with a 25G FNA needle. B) Diagram representing EUS guided transgastric hepatic vein puncture.

Figure 4

PPG levels according to presence or absence of clinical condition. Error bars denote standard deviation. p values of Wilcoxon rank sum test.