Huang Jason Y, Samarasena Jason B, Tsujino Takeshi, Chang Kenneth J
H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA.
Gastrointest Endosc. 2016 Aug;84(2):358-62. doi: 10.1016/j.gie.2016.02.032. Epub 2016 Mar 3.
Portal hypertension (PH) is a serious adverse event of liver cirrhosis. The hepatic venous pressure gradient (HVPG) accurately reflects the degree of PH and is the single best prognostic factor in liver disease. Currently, portal pressure gradient (PPG) measurement is performed at interventional radiology (IR) with a standard transjugular approach requiring radiation and intravenous contrast. The aim of this study was to develop a novel EUS-guided system using a 25G FNA needle and compact manometer to directly measure PPG and to evaluate its performance and clinical feasibility.
Experiments were performed in 3 swine that were under general anesthesia. Manometry was performed in venous (baseline and PH) and arterial (aorta) systems. The PH model was created by rapid Dextran-40 infusion peripherally. Under EUS guidance a 25G FNA needle with attached manometer was used to puncture (transgastric-transhepatic approach) and measure pressures in the portal vein, right hepatic vein (RHV), inferior vena cava (IVC), and aorta. With the IR approach, RHV (free and wedged), IVC, and aorta pressure were measured with an occlusion balloon. Pressure correlation was divided into 3 groups; low pressure (baseline), medium pressure (noncirrhotic portal hypertensive model), and high pressure (arterial). Correlation between the 2 methods of measurement was charted in scatter plots, and the Pearson's correlation coefficient (R) was calculated.
EUS identification, access, and manometry was successful in all targeted vessels. There was excellent correlation (R, .985-.99) between EUS and IR methods in all pressure ranges. No adverse event occurred.
This novel technique of EUS-PPG measurement using a 25G needle and novel manometer was feasible and demonstrated excellent correlation with the standard transjugular method throughout low, medium, and high pressure ranges.
门静脉高压（PH）是肝硬化的一种严重不良事件。肝静脉压力梯度（HVPG）能准确反映PH的程度，是肝病中最佳的单一预后因素。目前，门静脉压力梯度（PPG）测量是在介入放射学（IR）中采用标准经颈静脉途径进行，需要辐射和静脉造影剂。本研究的目的是开发一种新型的超声内镜引导系统，使用25G细针穿刺抽吸活检针和紧凑型压力计直接测量PPG，并评估其性能和临床可行性。
对3只接受全身麻醉的猪进行实验。在静脉（基线和PH）和动脉（主动脉）系统中进行测压。通过外周快速输注右旋糖酐-40建立PH模型。在超声内镜引导下，使用连接压力计的25G细针穿刺抽吸活检针（经胃-经肝途径），测量门静脉、右肝静脉（RHV）、下腔静脉（IVC）和主动脉的压力。采用IR方法，用阻塞球囊测量RHV（游离和楔压）、IVC和主动脉压力。压力相关性分为3组：低压（基线）、中压（非肝硬化门静脉高压模型）和高压（动脉）。在散点图中绘制两种测量方法之间的相关性，并计算Pearson相关系数（R）。
在所有目标血管中，超声内镜识别、穿刺和测压均成功。在所有压力范围内，超声内镜和IR方法之间均具有良好的相关性（R，0.985 - 0.99）。未发生不良事件。
这种使用25G针和新型压力计进行超声内镜PPG测量的新技术是可行的，并且在低、中及高压范围内与标准经颈静脉方法均显示出良好的相关性。
