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. 2025 May;45(5):e70096.
doi: 10.1111/liv.70096.

Prognostic Role of Endoscopic Ultrasound Guided Direct Portal Pressure Gradient Measurement in Porto-Sinusoidal Vascular Disorder

Francesco Santopaolo  1 , Lucia Giuli  1 , Giulia Tripodi  2 , Maria Pallozzi  1 , Francesca Romana Ponziani  1 , Brigida Eleonora Annicchiarico  1 , Gianenrico Rizzatti  2 , Andrea Contegiacomo  3 , Alessandro Posa  3 , Roberto Iezzi  3 , Rosa Talerico  4 , Antonio Gasbarrini  1 , Alberto Larghi  2
Affiliations

Prognostic Role of Endoscopic Ultrasound Guided Direct Portal Pressure Gradient Measurement in Porto-Sinusoidal Vascular Disorder

Francesco Santopaolo et al. Liver Int. 2025 May.

Abstract

Background & aims: HVPG is the gold standard for the diagnosis of clinically significant portal hypertension (CSPH), a condition associated with the risk of developing hepatic decompensation events. However, HVPG is an indirect method to measure portal pressure, and its application in the pre-sinusoidal form of portal hypertension (PH), as in porto-sinusoidal vascular disorder (PSVD), is hindered by low accuracy. Recently, endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement, which allows direct measurement of portal pressure, is emerging as a safe method and may overcome the limitation of HVPG. However, data in patients with CSPH and the pre-sinusoidal form of PH are still missing. This study aims to evaluate the safety and usefulness of EUS-PPG compared to HVPG in a cohort of patients with PSVD and CSPH.

Methods: In this prospective single center study, patients with a diagnosis of PSVD who presented a clinical suspicion of CSPH underwent HVPG and EUS-PPG baseline measurements. A second EUS-PPG measurement was performed in patients naïve to non-selective beta-blockers (NSBBs) to evaluate haemodynamic response to therapy.

Results: Twenty-six patients were enrolled and a total of 26 HVPG and 35 EUS-PPG measurements were performed, without any adverse events. Mean EUS-PPG was significantly higher than mean HVPG value (16.7 ± 5.5 mmHg versus 5.5 ± 2.8 mmHg). At logistic multivariate regression analysis, EUS-PPG value was the only variable associated with hepatic decompensation.

Conclusions: EUS-PPG measurement is safe and might have a prognostic role in patients with PSVD and CSPH, outperforming HVPG.

Trial registration: ID5486.

Keywords: clinically significant portal hypertension; endo‐hepatology; esophago‐gastric varices; portal pressure gradient; porto‐sinusoidal vascular disorder.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Endoscopic ultrasound‐guided measurement of portal vein pressure.
FIGURE 2
FIGURE 2
Endoscopic ultrasound‐guided measurement of hepatic vein pressure.
See this image and copyright information in PMC

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