EUS-GUIDED LIVER BIOPSY AND PORTAL PRESSURE MEASUREMENT COMPARED TO TRANSJUGULAR APPROACH: A RANDOMIZED CONTROLLED TRIAL.

Abstract

Background and aims: The transjugular (TJ) technique is recommended for the simultaneous evaluation of portal hypertension and hepatic fibrosis, with the hepatic venous pressure gradient (HVPG) and liver biopsy (LB), respectively. Unfortunately, technical challenges have restricted access to HVPG, and TJ-LB are often of suboptimal quality. Endoscopic ultrasound (EUS) is a novel approach capable of obtaining portal pressure gradient (PPG) and LB. Our aim was to compare EUS-PPG-LB to TJ-HVPG-LB.

Methods: Patients with chronic liver disease simultaneously evaluated for portal hypertension and liver fibrosis at the McGill University Health Centre were randomly assigned to EUS-PPG-LB or TJ-HVPG-LB. The primary endpoint was the combination of adequate LB (Guideline recommendation: ≥25mm total length and ≥11 complete portal tracts) and reliable HVPG/PPG (expert consensus: two measures within ≤1mmHg). Secondary endpoints assessed technical success, LB quality, HVPG/PPG reliability, patient satisfaction, and adverse events. Intention-to-treat analyses were conducted.

Results: Fifty-eight patients were randomized; 29 EUS and 29 TJ. Technical success was 90.0% for EUS and 96.6% for TJ (relative risk [RR], 0.93; 95% confidence interval [CI] 0.81-1.07). Combined adequate LB and reliable HVPG/PPG was 82.8% for EUS and 41.4% for TJ (RR 2.00; 95%CI 1.26-3.18). Proportion of adequate LB was 93.1% for EUS and 41.4% for TJ (RR 2.25; 95%CI 1.44-3.51). Proportion of reliable HVPG/PPG was 89.7% for EUS and 58.6% for TJ (RR 1.53; 95%CI 1.10-2.13).We found no between-group difference in adverse events.

Conclusion: EUS is superior to TJ for simultaneous acquisition of adequate LB and reliable PPG, suggesting it has an important role in evaluating chronic liver diseases.