Endoscopic Ultrasound Guided Portosystemic Pressure Gradient Correlates with Clinical Parameters and Liver Histology.

Abstract

Background/aims: Endoscopic ultrasound guided portosystemic pressure gradient measurement (EUS-PPG) is a novel technique to evaluate for portal hypertension (PH), a diagnosis that can prognosticate and guide therapy for patients. This study evaluated the safety and efficacy of EUS-PPG and correlation with clinical parameters and liver histology.

Methods: We conducted a multi-center, retrospective study of patients undergoing EUS-PPG from January 2020 to December 2022 for suspected liver disease or PH. Linear regression was used to examine the relationship between EUS-PPG and clinical parameters of PH and the chi square test, Fisher's exact test, and Wilcoxon Rank Sums test described correlation with liver biopsy histology and non-invasive markers of fibrosis (FIB-4, APRI). Logistic regression was performed to identify the strongest predictor of histologic cirrhosis.

Results: Across 8 centers, 385 patients were enrolled and 373 had successful EUS-PPG (technical success 97%). Higher median PPGs were observed in patients with than without esophageal varices (11.6mmHg vs 4.1), portal hypertensive gastropathy (10.5mmHg vs 3.3), and thrombocytopenia (7.6 mmHg vs 4.4) (p<0.001). Individuals with PH and clinically significant PH (PPG>10) were 6.7 and 3.8 times more likely to have cirrhosis on histology. EUS-PPG was the best overall predictor of biopsy proven cirrhosis (AUC 0.84) compared to FIB-4 (0.72), and APRI (0.54). There were 2 minor adverse events related to PPG (post procedural pain).

Conclusions: EUS-PPG measurement was technically feasible, safe and demonstrated strong correlation with clinical parameters of PH and liver histology. The strongest predictor of cirrhosis was EUS-PPG >5mm Hg which outperformed non-invasive markers of fibrosis.