Endoscopic ultrasound-guided portal pressure gradient with liver biopsy: 6 years of endo-hepatology in practice
Declaration of conflict of interest: Alyssa Y. Choi, Jennifer Kolb, Sagar Shah, Anastasia Chahine, Rintaro Hashimoto, Anish Patel, Takeshi Tsujino, Jason Huang, Ke-Qin Hu: None declared. Kenneth Chang: Consultant: Cook Medical, Olympus, Medtronic, Endogastric Solutions, ERBE. Jason B. Samarasena: Consultant/Advisory Board: Olympus, Medtronic, Pentax, Conmed, Steris, Pathfinder, Microtech, Mauna Kea; Ownership: Docbot; Educational Grant: Cook Medical, Conmed.
Author contribution: Alyssa Y. Choi: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Jennifer Kolb: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Sagar Shah: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Anastasia Chahine: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Rintaro Hashimoto: conception and design; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Anish Patel: conception and design; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Takeshi Tsujino: conception and design; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Jason Huang: conception and design; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Ke-Qin Hu: conception and design; drafting of the article; critical revision of the article for important intellectual content; final approval of the article. Kenneth Chang: conception and design; drafting of the article; critical revision of the article for important intellectual content; completion of procedures; final approval of the article. Jason B. Samarasena: conception and design; analysis and interpretation of the data; drafting of the article; critical revision of the article for important intellectual content; final approval of the article.
Abstract
Background and Aim
The portal pressure gradient (PPG) is a useful predictor of portal hypertension (PH) related complications. We previously showed the feasibility and safety of endoscopic ultrasound guided PPG measurement (EUS-PPG). Now EUS-guided liver biopsy (EUS-bx) has been shown to be a safe and effective alternative to percutaneous or Interventional Radiology-guided liver biopsy for the diagnosis of chronic liver disease (CLD). We aimed to evaluate the correlation between PPG and clinical markers of PH, and assess the feasibility and safety of concomitant, single session EUS-PPG and EUS-bx.
Methods
This was a retrospective study of patients undergoing EUS-PPG for CLD at a single tertiary endoscopy center between February 2014 and March 2020. EUS-PPG was performed using a 25-gauge needle and compact manometer. Data analysis was performed with SAS version 9.4.
Results
Eighty-three patients underwent EUS-PPG with 100% technical success. The mean PPG was 7.06 mmHg (SD 6.09, range 0–27.3). PPG was higher in patients with (vs without) clinical features of cirrhosis (9.46 vs 3.61 mmHg, P < 0.0001), esophageal or gastric varices (13.88 vs 4.34 mmHg, P < 0.0001), and thrombocytopenia (9.25 vs 4.71 mmHg, P = 0.0022). In the 71 patients (85.5%) who underwent EUS-bx, 70 (98.6%) specimens were deemed adequate by the pathologist for histologic diagnosis. There were no early or late major adverse events.
Conclusion
EUS-PPG correlates well with clinical markers of PH. EUS-bx can be performed safely during the same session as EUS-PPG, providing a comprehensive endoscopic evaluation of the patient with CLD.
