Hajifathalian Kaveh, Westerveld Donevan, Kaplan Alyson, Dawod Enad, Herr Andrea, Ianelli Mallory, Saggese Allysa, Kumar Sonal, Fortune Brett E, Sharaiha Reem Z
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
Gastrointest Endosc. 2022 Apr;95(4):703-710. doi: 10.1016/j.gie.2021.11.037. Epub 2021 Dec 7.
The measurement of the portosystemic pressure gradient (PSG) in patients with advanced liver disease is helpful to assess the severity of portal hypertension (PH) and predict adverse clinical outcomes. EUS-guided PSG (EUS-PSG) measurement is a novel tool to assess PSG in all patients with advanced liver disease. We sought to assess the safety, feasibility, and technical success of simultaneous EUS-PSG measurement and EUS-guided liver biopsy sampling using a single-center experience.
Patients with suspected liver disease or cirrhosis were enrolled prospectively from 2020 to 2021. EUS-PSG was measured by calculating the difference between the mean portal pressure and the mean hepatic vein pressure. PH was defined as PSG >5 mm Hg and clinically significant PH as PSG ≥10 mm Hg. The primary outcomes were procedural technical success rate and correlation of EUS-PSG with fibrosis stage obtained from concurrent EUS-guided liver biopsy sampling and the correlation of EUS-PSG with patients' imaging, clinical, and laboratory findings. The secondary outcome was occurrence of procedural adverse events (AEs).
Twenty-four patients were included in the study. PSG measurement and EUS-guided liver biopsy sampling were successful in 23 patients (technical success rate of 96%) and 24 patients (100% success), respectively. Analysis revealed a significant association between both PSG and liver stiffness measured on transient elastography (P = .011) and fibrosis-4 score (P = .026). No significant correlation was found between the fibrosis stage on histology and measured PSG (P = .559). One mild AE of abdominal pain was noted. Additionally, EUS-PSG was predictive of clinically evident PH.
Simultaneous EUS-PSG measurement and EUS-guided liver biopsy sampling were both feasible and safe and correlated with clinically evident PH and noninvasive markers of fibrosis.
晚期肝病患者的肝静脉压力梯度（PSG）测量有助于评估门静脉高压（PH）的严重程度并预测不良临床结局。超声内镜引导下PSG（EUS-PSG）测量是评估所有晚期肝病患者PSG的一种新工具。我们试图通过单中心经验评估同时进行EUS-PSG测量和超声内镜引导下肝活检采样的安全性、可行性和技术成功率。
2020年至2021年对疑似肝病或肝硬化患者进行前瞻性研究。通过计算平均门静脉压力与平均肝静脉压力之间的差值来测量EUS-PSG。PH定义为PSG>5 mmHg，临床显著PH定义为PSG≥10 mmHg。主要结局为操作技术成功率、EUS-PSG与同期超声内镜引导下肝活检采样获得的纤维化分期的相关性，以及EUS-PSG与患者影像学、临床和实验室检查结果的相关性。次要结局为操作不良事件（AE）的发生情况。
24例患者纳入研究。PSG测量和超声内镜引导下肝活检采样分别在23例患者中成功（技术成功率96%）和24例患者中成功（成功率100%）。分析显示PSG与瞬时弹性成像测量的肝硬度（P = 0.011）和纤维化-4评分（P = 0.026）之间均存在显著相关性。组织学纤维化分期与测量的PSG之间未发现显著相关性（P = 0.559）。记录到1例轻度腹痛AE。此外，EUS-PSG可预测临床明显的PH。
同时进行EUS-PSG测量和超声内镜引导下肝活检采样既可行又安全，且与临床明显的PH和纤维化的非侵入性标志物相关。
