EUS-Guided Portal Pressure Gradient Measurement in Prehepatic Portal Hypertension

Endoscopic Ultrasound-Guided Portal Pressure Gradient Measurement in Patients With Prehepatic Portal Hypertension: A Retrospective Observational Study

Portal hypertension caused by prehepatic vascular obstruction, such as portal vein thrombosis or portal vein tumor thrombosis, represents a unique hemodynamic condition in which conventional hepatic venous pressure gradient (HVPG) measurement may not accurately reflect portal venous pressure. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement provides a direct approach for assessing portal hemodynamics.

This retrospective observational study included patients with cirrhosis and esophagogastric varices complicated by portal vein thrombosis or portal vein tumor thrombosis. All patients underwent abdominal computed tomography to confirm the presence of portal vein obstruction, liver stiffness measurement by ultrasound elastography, HVPG measurement, and EUS-PPG measurement. The study aims to evaluate the relationship between EUS-PPG and HVPG and to explore the associations between portal pressure measurements and clinical characteristics, including underlying liver disease etiology, liver function grade, sex, gastrointestinal bleeding, and hepatic encephalopathy.

Inclusion Criteria:

Age ≥18 years; Confirmed diagnosis of cirrhosis complicated by portal venous obstructionbased on clinical, laboratory, and imaging findings; Written informed consent;

Exclusion Criteria:

Severe coagulopathy, defined as an International Normalized Ratio (INR) >1.5; Severe thrombocytopenia, defined as a platelet count <30 × 10^9/L; Severe systemic comorbidities, including active sepsis, decompensated heart failure, or severe chronic obstructive pulmonary disease; Psychiatric or cognitive disorders that preclude cooperation with study procedures; Refusal to undergo hepatic venous pressure gradient (HVPG) or endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement;