EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT (EUS-PPG). PRELIMINARY RESULTS COMPARED WITH HEPATIC VENOUS PRESSURE GRADIENT (HVPG)

Aims Evaluate technical success and related complications associated to EUS-GPP in cirrhotic patients. Secondary endpoint: explore the correlation between EUS-PPG and HVPG in cirrhotic patients.

Methods Prospective observational study in a tertiary hospital. Patients with diagnosed or suspected cirrhosis and indication of measurement of portal pressure gradient were enrolled. We performed EUS-GPP with a conventional endoscopic ultrasonography 22G needle and a central venous pressure monitor in the endoscopic unit. In a subgroup HVPG was also performed with the standard radiologic method. We used mean values for descriptive variables and Intraclass correlation coefficient for EUS-GPP/HVPG correlation.

Results Twenty six patients were included. Hepatic function was Child 7,4±2,1 y MELD-Na 13,2±5,6. Success rate of EUS-GPP was in 24/26 patients (92,3%). It wasn’t possible to perform EUS-GPP in two cases, one because of impossibility of sedation, and one because of lack of vascular access for IVC and suprahepatic veins in a liver transplant patient. There was one complication (3,8%): mild upper gastrointestinal bleeding endoscopically treated. In 25/26 propofol was exclusively used for the sedation. In 81% another endoscopy was associated. Mean time for the procedure was 25,6±12,7min. In 17 patients EUS-GPP and HVPG were performed. Mean EUS-GPP was 17,2±5,2 mmHg and 18,1±3,9 mmHg in the HVPG group, p=0,3. Intraclass correlation coefficient between EUS-GPP and GPVH was 0,75.

Conclusions EUS-GPP measurement in cirrhotic patients is an effective and safe procedure that allows direct measurement of the portal pressure. Good correlation with HVPG is observed. EUS-GPP could become the new gold standard.

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Artikel online veröffentlicht:
14. April 2022