Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Gastrointest Endosc. 2021 Mar;93(3):565-572. doi: 10.1016/j.gie.2020.06.065. Epub 2020 Jun 29.
EUS-guided portal pressure gradient (EUS-PPG) measurement is a novel method to evaluate portal hypertension severity. In this study, we determined the consistency between EUS-PPG and hepatic venous pressure gradient (HVPG) measurements in patients with acute or subacute portal hypertension.
Twelve patients were prospectively enrolled. EUS-PPG measurements were performed using a 22-gauge FNA needle and a central venous pressure measurement monitor. The HVPG measurements were performed using the transjugular approach. If an HVPG measurement was not attainable and the patient underwent transjugular intrahepatic portosystemic shunt (TIPS) treatment, a PPG was recorded as a reference standard during the procedure. We assessed the feasibility and safety of EUS-PPG and calculated the correlation between the 2 measurements.
EUS-PPG measurements were successful in 11 patients (91.7%). Subsequent HVPG measurements failed in 2 patients with Budd-Chiari syndrome (hepatic vein occlusion subtype), 1 of whom underwent TIPS treatment to obtain transjugular PPG data. A small shunt was found during 1 HVPG measurement that introduced inaccuracy. Nine patients were included in the statistical analysis. Mean EUS-PPG and HVPG/PPG (transjugular) were 18.07 ± 4.32 mm Hg and 18.82 ± 3.43 mm Hg, respectively. Pearson's correlation coefficient between the 2 methods was .923 (P < .001).
EUS-PPG measurement using a 22-gauge FNA needle was a safe and accurate method to evaluate portal hypertension and has the potential to supplement the measurement of HVPG in liver diseases. (Clinical trial registration number: ChiCTR1800017317.).
EUS 引导的门脉压力梯度（EUS-PPG）测量是评估门静脉高压严重程度的一种新方法。本研究旨在确定 EUS-PPG 与急性或亚急性门静脉高压患者肝静脉压力梯度（HVPG）测量之间的一致性。
本研究前瞻性纳入 12 例患者。EUS-PPG 测量使用 22 号 FNA 针和中心静脉压测量监测仪进行。HVPG 测量采用经颈静脉途径进行。如果无法进行 HVPG 测量且患者接受经颈静脉肝内门体分流术（TIPS）治疗，则在该过程中记录 PPG 作为参考标准。我们评估了 EUS-PPG 的可行性和安全性，并计算了两种测量方法之间的相关性。
11 例患者（91.7%）成功进行了 EUS-PPG 测量。2 例布加综合征（肝静脉阻塞型）患者后续 HVPG 测量失败，其中 1 例接受 TIPS 治疗以获得经颈静脉 PPG 数据。1 例 HVPG 测量中发现小分流，导致测量不准确。9 例患者纳入统计分析。EUS-PPG 和 HVPG/PPG（经颈静脉）的平均值分别为 18.07 ± 4.32mmHg 和 18.82 ± 3.43mmHg。两种方法之间的 Pearson 相关系数为.923（P<0.001）。
使用 22 号 FNA 针进行 EUS-PPG 测量是一种安全、准确的评估门静脉高压的方法，有可能补充肝脏疾病中 HVPG 的测量。（临床试验注册号：ChiCTR1800017317。）
