Simultaneous EUS-guided portosystemic pressure measurement and liver biopsy correlate with clinically meaningful outcomes.
Academic Article
Overview
abstract
BACKGROUND AND AIMS: The measurement of the portosystemic gradient (PSG) in patients with advanced liver disease is helpful in order to assess the severity of portal hypertension (PH) and predict adverse clinical outcomes. Endoscopic ultrasound-guided PSG (EUS-PSG) measurement is a novel tool to assess PSG in all patients with advanced liver disease. We sought to assess the safety, feasibility, and technical success of simultaneous EUS-PSG measurement and EUS-guided liver biopsy using a single center experience. METHODS: Patients with suspected liver disease or cirrhosis were enrolled prospectively from 2020 to 2021. EUS-PSG was measured by calculating the difference between the mean portal pressure and the mean hepatic vein pressure. PH was defined as PSG >5 mm Hg, clinically significant portal hypertension was defined as PSG ≥10 mm Hg. The primary outcomes were procedural technical success rate and correlation of EUS-PSG with fibrosis stage obtained from concurrent EUS-liver biopsy, as well as correlation of EUS-PSG with patients' imaging, clinical, and laboratory findings. The secondary outcome was occurrence of procedural adverse events (AEs). RESULTS: Twenty-four patients were included in the study. PSG measurement and EUS-liver biopsy were successful in 23 patients (technical success rate of 96%) and 24 patients (100% success), respectively. Analysis revealed a significant association between both PSG and liver stiffness measured on transient elastography (p=0.011) and FIB-4 score (p=0.026) There was no significant correlation between the fibrosis stage on histology and measured PSG (p=0.559). There was one mild adverse event due to abdominal pain. Additionally, EUS-PSG was predictive of clinically evident PH. CONCLUSIONS: Simultaneous EUS-PSG measurement and EUS-guided liver biopsy were both feasible and safe and correlated with clinically evident PH as well as noninvasive markers of fibrosis.
