Endoscopic ultrasound-guided portal pressure gradient measurement: a systematic review and meta-analysis

Abstract

Background: Endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPG) is a new modality where the portal pressure is measured by directly introducing a needle into the hepatic vein and portal vein. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of EUS-PPG.

Methods: A comprehensive literature search was performed to identify pertinent studies. The primary outcomes assessed were the technical and clinical success of EUS-PPG. Technical success was defined as successful introduction of the needle into the desired vessel, while clinical success was defined as the correlation of the stage of fibrosis on the liver biopsy to EUS-PPG, or concordance of HVPG and EUS-PPG. The secondary outcomes were pooled rates for total and individual adverse events related to EUS-PPG. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI).

Results: Eight cohort studies with a total of 178 patients were included in our analysis. The calculated pooled rates of technical success and clinical success were 94.6% (95%CI 88.5-97.6%; P=<0.001; I²=0) and 85.4% (95%CI 51.5-97.0%; P=0.042; I²=70), respectively. The rate of total adverse events was 10.9% (95%CI 6.5-17.7%; P=<0.001; I²=4), and 93.7% of them were mild, as defined by the American Society for Gastrointestinal Endoscopy. Abdominal pain (11%) was the most common adverse event, followed by bleeding (3.6%). There were no cases of perforation or death reported in our study.

Conclusions: EUS-PPG is a safe and effective modality for diagnosing portal hypertension. Further randomized controlled trials are needed to validate our findings.

Keywords: Endoscopic ultrasound; cirrhosis; portal hypertension; portal pressure gradient.

Figure 1

Forest plot showing the technical success of endoscopic ultrasound-guided portal pressure gradient measurement CI, confidence interval

Figure 2

Forest plot showing the clinical success of endoscopic ultrasound-guided portal pressure gradient measurement CI, confidence interval

Figure 3

Forest plot showing overall adverse events associated with endoscopic ultrasound-guided portal pressure gradient measurement CI, confidence interval