Endoscopic Ultrasound-guided Measurement of Portal Vein Pressure Gradient

Study on the Measurement of Portal Vein Pressure Gradient Guided by Endoscopic Ultrasound Based on Portal Vein Thrombosis and Portal Hypertension

This study aims to evaluate the accuracy and safety of a novel endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement technique in 42 adults with liver cirrhosis and portal vein thrombosis (blood clots in the liver's main vein), a condition where current standard testing (HVPG) fails to provide reliable pressure readings. Participants will undergo both EUS-PPG (using a specialized needle under ultrasound guidance) and HVPG procedures to compare results; EUS-PPG will be performed under general anesthesia in a left-side lying position-an innovative approach-while also enabling immediate endoscopic treatment of bleeding veins if detected during the same session. The primary goals are to validate EUS-PPG's safety in this high-risk group, establish its correlation with HVPG, and pioneer an integrated diagnosis-treatment protocol to reduce hospital stays and costs. The study runs from July 2025 to June 2027 at Zhejiang University School of Medicine.

Inclusion Criteria:

• Age ≥ 18 years old
• History of liver cirrhosis
• INR < 1.5
• Platelet count > 50 × 10⁹/L
• Patients agreed to HVPG and EUS-PPG measurements

Exclusion Criteria:

• Patients with ascites
• Patients with renal insufficiency
• Patients with active infection
• Patients with hepatic encephalopathy
• Critically ill patients
• Pregnant patients
• Patients with immunodeficiency diseases (such as systemic lupus erythematosus)
• Patients with mental illness
• Patients with malignant tumors
• Patients who refused to undergo HVPG and EUS-PPG measurements