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

Abstract

Background and aims: Portal hypertension is a serious adverse event of liver cirrhosis. Recently, we developed a simple novel technique for EUS-guided portal pressure gradient (PPG) measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and interventional radiology-acquired PPGM. In this video we demonstrate the results of 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 FNA needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted by use of a transgastric or transduodenal approach. 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).

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.

Keywords: HV, hepatic vein; HVPG, HV pressure gradient; PH, portal hypertension; PPG, portal pressure gradient; PPGM, PPG measurement; PV, portal vein; WHVP, wedged HV pressure.

Figure 1

Compact manometer.

Figure 2

A, EUS image of transgastric transhepatic needle puncture into the portal vein with a 25-gauge FNA needle. B, Representation of EUS-guided transgastric portal vein puncture.

Figure 3

A, EUS image of transgastric transhepatic needle puncture into the hepatic vein with a 25-gauge FNA needle. B, Representation of EUS-guided transgastric hepatic vein puncture.