Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study

IF 9.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

JHEP Reports Pub Date : 2025-05-29 DOI:10.1016/j.jhepr.2025.101466

Emma Vanderschueren , Wim Laleman , Lawrence Bonne , Geert Maleux , David R. Wagner , Chyon Yeh , Andrea Calvo , Oriol Sendino , Angels Gines , Anna Baiges , Marco J. Bruno , Juan Carlos Garcia-Pagan , Schalk van der Merwe

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引用次数: 0

Abstract

Background & Aims

Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availability pose challenges. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) provides a direct alternative. The ENCOUNTER study is the first to compare EUS-PPG to HVPG in the same patient, simultaneously.

Methods

This prospective, international, bicentric study included patients referred for HVPG or transjugular intrahepatic portosystemic shunt (TIPS) placement at the University Hospital of Leuven (Belgium) and Hospital Clinic Barcelona (Spain). Patients underwent standard-of-care HVPG, followed by simultaneous HVPG and EUS-PPG measurements under propofol general anesthesia.

Results

The final analysis included 21 patients with cirrhosis undergoing simultaneous HVPG and EUS-PPG measurements, of whom 15 received TIPS. Mean HVPG and EUS-PPG values under general anesthesia were comparable (11.9 ± 5.2 vs. 10.9 ± 5.6 mmHg, p = 0.2332) and showed good correlation (r = 0.74, p = 0.0001). The individual pressure components also showed a good correlation (portal vein: r = 0.85, p <0.0001; hepatic vein: r = 0.72, p = 0.0003). In patients receiving TIPS, direct transjugular portal pressure measurements demonstrated an excellent correlation with EUS-guided portal pressures (r = 0.91, p <0.0001). Technical success was achieved in all cases, with no adverse events associated with the EUS-PPG procedure.

Conclusion

EUS-PPG is a reliable and safe alternative to HVPG for the direct measurement of portal pressure. However, attention must be paid to technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia, which may alter pressure measurements and subsequently affect risk classification.

Impact and implications

The ENCOUNTER study is the first study to directly compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with hepatic venous pressure gradient (HVPG) in the same patients, simultaneously. EUS-PPG is a safe and reliable direct alternative to HVPG for measuring portal pressure. However, technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia must be considered. EUS-PPG is particularly attractive for patients with chronic liver disease who have conflicting non-invasive test results, require additional endoscopic procedures, or in cases where HVPG may underestimate true portal pressure.

ClinicalTrials.gov

NCT04987034.

Abstract Image

查看原文本刊更多论文

超声内镜下测量肝硬化患者门静脉系统压力梯度与经颈静脉球囊闭塞测量（ENCOUNTER）：一项双中心的欧盟研究

背景,目的肝硬化和门静脉高压症患者发生肝功能失代偿和肝脏相关死亡的风险增加。虽然肝静脉压力梯度（HVPG）是量化门静脉高压的公认方法，但其测量和有限的可用性带来了挑战。内镜超声引导门静脉压力梯度（EUS-PPG）提供了一个直接的选择。ENCOUNTER研究是首次在同一患者中同时比较EUS-PPG和HVPG。方法：这项前瞻性、国际性、双中心研究纳入了在比利时鲁汶大学医院和西班牙巴塞罗那医院诊所接受HVPG或经颈静脉肝内门静脉分流术（TIPS）安置的患者。患者接受标准护理HVPG，然后在异丙酚全身麻醉下同时进行HVPG和EUS-PPG测量。结果最终分析包括21例同时进行HVPG和EUS-PPG测量的肝硬化患者，其中15例接受TIPS。全麻下HVPG平均值与EUS-PPG值具有可比性（11.9±5.2 vs. 10.9±5.6 mmHg, p = 0.2332），相关性良好（r = 0.74, p = 0.0001）。各单项压力组分也表现出良好的相关性(门静脉：r = 0.85, p <0.0001；肝静脉：r = 0.72, p = 0.0003)。在接受TIPS的患者中，直接经颈静脉门静脉压力测量显示与eus引导的门静脉压力有很好的相关性（r = 0.91, p <0.0001）。所有病例均取得了技术上的成功，没有出现与EUS-PPG相关的不良事件。结论eus - ppg是替代HVPG直接测量门静脉压力可靠、安全的方法。然而，必须注意技术挑战，包括eus引导下肝静脉压力的潜在高估和全身麻醉的影响，这可能会改变压力测量，从而影响风险分类。影响和意义ENCOUNTER研究是首个在同一患者中直接比较内镜超声引导门静脉压力梯度（EUS-PPG）和肝静脉压力梯度（HVPG）的研究。EUS-PPG是一种安全可靠的直接替代HVPG测量门静脉压力的方法。然而，必须考虑技术挑战，包括eus引导下肝静脉压力的潜在高估和全身麻醉的影响。对于非侵入性检查结果不一致、需要额外内镜检查或HVPG可能低估门静脉真实压力的慢性肝病患者，EUS-PPG尤其具有吸引力。

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来源期刊

JHEP Reports GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

12.40

自引率

2.40%

发文量

161

审稿时长

36 days

期刊介绍： JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology. The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies. In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.