Simultaneous EUS-guided portosystemic pressure measurement and liver biopsy sampling correlate with clinically meaningful outcomes

Published:December 06, 2021DOI:

      Background and Aims

      The measurement of the portosystemic pressure gradient (PSG) in patients with advanced liver disease is helpful to assess the severity of portal hypertension (PH) and predict adverse clinical outcomes. EUS-guided PSG (EUS-PSG) measurement is a novel tool to assess PSG in all patients with advanced liver disease. We sought to assess the safety, feasibility, and technical success of simultaneous EUS-PSG measurement and EUS-guided liver biopsy sampling using a single-center experience.


      Patients with suspected liver disease or cirrhosis were enrolled prospectively from 2020 to 2021. EUS-PSG was measured by calculating the difference between the mean portal pressure and the mean hepatic vein pressure. PH was defined as PSG >5 mm Hg and clinically significant PH as PSG ≥10 mm Hg. The primary outcomes were procedural technical success rate and correlation of EUS-PSG with fibrosis stage obtained from concurrent EUS-guided liver biopsy sampling and the correlation of EUS-PSG with patients' imaging, clinical, and laboratory findings. The secondary outcome was occurrence of procedural adverse events (AEs).


      Twenty-four patients were included in the study. PSG measurement and EUS-guided liver biopsy sampling were successful in 23 patients (technical success rate of 96%) and 24 patients (100% success), respectively. Analysis revealed a significant association between both PSG and liver stiffness measured on transient elastography (P = .011) and fibrosis-4 score (P = .026). No significant correlation was found between the fibrosis stage on histology and measured PSG (P = .559). One mild AE of abdominal pain was noted. Additionally, EUS-PSG was predictive of clinically evident PH.


      Simultaneous EUS-PSG measurement and EUS-guided liver biopsy sampling were both feasible and safe and correlated with clinically evident PH and noninvasive markers of fibrosis.


      AE (adverse events), CSPH (clinically significant portal hypertension), FIB-4 (fibrosis-4), HVPG (hepatic venous pressure gradient), INR (international normalized ratio), NAFLD (nonalcoholic fatty liver disease), NAS (NAFLD activity score), NFS (NAFLD fibrosis score), PH (portal hypertension), PSG (portosystemic pressure gradient)
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      Linked Article

      • Sedation during EUS-guided portal pressure gradient measurement: the elephant in the room
        Gastrointestinal EndoscopyVol. 96Issue 4
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          In the April issue of Gastrointestinal Endoscopy, Hajifathalian et al1 reported their experience with the simultaneous acquisition of EUS-guided portosystemic pressure gradient (EUS-PPG) and liver biopsy. They showed that EUS-PPG is feasible and safe, with a technical success rate of 96% and the occurrence of 1 mild adverse event (4%, 1/24), respectively. This well-conducted study further supports the role of EUS in the evaluation of portal hypertension, and it challenges the hepatic venous pressure gradient (HVPG) obtained by the transjugular approach.
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