UEG's content platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

Re-live UEG Week 2026 on Gutflix Gut Guide online What's new on Gutflix

Trending on Gutflix

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

ENDOSCOPIC ULTRASOUND DIRECT PORTAL PRESSURE MEASUREMENT IS MORE RELIABLE THAN HEPATIC VENOUS PRESSURE GRADIENT MEASUREMENT IN PATIENTS WITH PRE-SINUSOIDAL FORMS OF PORTAL HYPERTENSION

Lucia Giuli 1, Gianenrico Rizzatti 1, Francesco Santopaolo 1, Francesca Romana Ponziani 1, Andrea Contegiacomo 1, Giulia Tripodi 1, Giulia Venturini 1, Brigida Annicchiarico 1, Cristiano Spada 1, Antonio Gasbarrini 1, Alberto Larghi 1

Affiliations

1 Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy

Summary

AI Generated

A 14-patient study found that EUS-guided portal pressure gradient measurement was safe and detected significantly higher values than HVPG in patients with pre-sinusoidal portal hypertension, suggesting it may be more reliable than the gold-standard indirect method in this population.

EUS-guided PPG measurement was technically successful in all 14 patients with pre-sinusoidal portal hypertension (etiologies: 71.4% PSVD, 21.4% NAFLD-cirrhosis, 7.2% PBC) with no adverse events and no platelet transfusions required despite 21% having platelet counts below 50,000 per microliter.
Mean EUS-PPG was 18.7 ± 3.4 mmHg compared to 9 ± 4.4 mmHg by HVPG (p<0.0001), consistent with the known limitation that HVPG may underestimate portal pressure in pre-sinusoidal forms of portal hypertension.
In four patients naive to non-selective beta-blockers, repeat EUS-PPG after drug titration showed mean PPG decrease from 19.7 to 17 mmHg, with one of four achieving greater than 20% reduction.
The authors conclude that EUS-guided PPG could be used to assess hemodynamic response to therapy in patients with pre-sinusoidal portal hypertension.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Hepatic venous pressure gradient (HVPG) represents the gold standard for the evaluation of portal hypertension (PH). HVPG > 10 mmHg defines clinically significant portal hypertension (CSPH), a condition that is independently associated with the occurrence of decompensation events. Portal pressure measurement is of fundamental importance for prognostic stratification and assessment of response to therapies. Indeed, a decrement of HVPG by 20% and/or < 10 mmHg reduces the decompensation risk. HVPG, however, indirectly measures PH and it may underestimate portal pressure gradient (PPG) in patients with pre-sinusoidal forms or with a pre-sinusoidal component of PH such in the case of initial stages of primary biliary cholangitis (PBC), non-alcoholic fatty liver disease (NAFLD), porto-sinusoidal vascular disorder (PSVD). Moreover, HVPG procedure is invasive, involves radiographic exposure, and requires use of intravenous contrast media. Endoscopic ultrasound (EUS)-guided PPG measurement has recently become available. This technique allows measurement of portal pressure directly in the portal vein system and theoretically overcomes HVPG limitations.

Aims & Methods

We investigated the safety and accuracy of EUS measurements as compared to HVPG in evaluating PPG in a cohort of patients with CSPH. In patients naïve to non-selective beta-blockers (NSBBs) hemodynamic response to therapy was also evaluated.
Consecutive outpatients with liver disease characterized by pre-sinusoidal forms of PH who presented specific sign(s) of CSPH (gastro-oesophageal varices and/or portosystemic collaterals) underwent HVPG and EUS-guided PPG measurements with Echotip Insight 25G device (Cook Ireland Ltd.). In patients naive to NSBBs, treatment was started and after its titration EUS-PPG measurement was repeated. Definition and severity of adverse events (AEs) were based on classification of Cotton et al.

Results

Between March 2022 and December 2022, fourteen patients (mean age 58 ± 15; 57% males; etiology NAFLD related-cirrhosis 21.4%, PBC 7.2%, PSVD 71.4%) were enrolled. Mean platelet count was 71.000 U/microliter with 21% of patients having platelet count < 50.000 U/microliter. A total of 18 EUS-guided PPG and 14 HVPG measurements were performed. EUS-PPG was technically successful in all cases, without any AEs and requirement for platelet transfusion. EUS-PPG mean value was 18.7 ± 3.4 mmHg versus 9 ± 4.4 mmHg of HVPG (p<0.0001). In four patients naive to NSBBs we repeated a new EUS-PPG measurement after drug titration. The average PPG value in these patients before and after NSBBs titration was respectively 19.7 (± 3.4) and 17 (± 2.7) mmHg, with one patient out of four who achieved a decrement of PPG > 20 %.

Conclusion

Direct EUS-guided PPG measurement is safe and significantly more reliable than HVPG in the evaluation of PH in patients with pre-sinusoidal forms of PH. This technique could be also used to assess hemodynamic response to therapy in these patients.

Disclosure

N/A

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

More Like This:

INSTITUTIONAL ENDOSCOPIC MANAGEMENT INCORPORATING INTENSIVE DOWNSTAGING POLYPECTOMY IS ASSOCIATED WITH REDUCED DUODENAL DISEASE PROGRESSION IN FAMILIAL ADENOMATOUS POLYPOSIS

Shinichiro Shinzaki

LIVER HISTOLOGY PREDICTS HEPATIC BUT NOT EXTRAHEPATIC OUTCOMES IN BIOPSY-PROVEN METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE: A MULTI-SITE UNITED KINGDOM COHORT STUDY

Mark Thursz

THE ATF6–MICROBIOTA AXIS DRIVES GOBLET CELL DYSFUNCTION AND MUCUS BARRIER DISRUPTION IN PROXIMAL COLON CANCER

Dirk Haller

WHEY-DERIVED FRACTIONS MITIGATE OXIDATIVE STRESS AND ENHANCE INTESTINAL BARRIER INTEGRITY IN CACO-2/TC7 CELLS

Laura Grasa

MODEL-SPECIFIC MECHANISMS OF BONE LOSS IN EXPERIMENTAL CHOLESTATIC LIVER DISEASE

Tomislav Kelava

DEEP LEARNING-BASED ENDOSCOPIC ULTRASOUND DIAGNOSIS OF FATTY PANCREAS: AGREEMENT WITH MRI AND PERFORMANCE OF AI MODELS

Paolo Giorgio Arcidiacono

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

INSTITUTIONAL ENDOSCOPIC MANAGEMENT INCORPORATING INTENSIVE DOWNSTAGING POLYPECTOMY IS ASSOCIATED WITH REDUCED DUODENAL DISEASE PROGRESSION IN FAMILIAL ADENOMATOUS POLYPOSIS

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

INSTITUTIONAL ENDOSCOPIC MANAGEMENT INCORPORATING INTENSIVE DOWNSTAGING POLYPECTOMY IS ASSOCIATED WITH REDUCED DUODENAL DISEASE PROGRESSION IN FAMILIAL ADENOMATOUS POLYPOSIS

Yuya Asada 1, Minoru Kato 2, Reona Kawamura 3, Hideki Ishikawa 4, Takuya Okugawa 1, Mari Mizutani 5, Chika Fukuyama 6, Mari Nezu 7, Akiko Chino 6, Motohiko Kato 5, Masayoshi Yamada 3, Tomoki Michida 2, Shinichiro Shinzaki 1

Affiliations

1 Hyogo Medical University School of Medicine, Hyogo, Japan

2 Osaka International Cancer Institute, Osaka, Japan

3 National Cancer Center Hospital, Tokyo, Japan

4 Ishikawa Gastroenterology Clinic, Osaka, Japan

5 Keio University School of Medicine, Tokyo, Japan

6 Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

7 Hyogo Medical University, Hyogo, Japan