H. H. Chao Comprehensive Digestive Disease Center, University of California, Los Angeles, California, USA.
Irvine Medical Center, Orange, California, USA.
J Gastroenterol Hepatol. 2022 Jul;37(7):1373-1379. doi: 10.1111/jgh.15875. Epub 2022 May 20.
The portal pressure gradient (PPG) is a useful predictor of portal hypertension (PH) related complications. We previously showed the feasibility and safety of endoscopic ultrasound guided PPG measurement (EUS-PPG). Now EUS-guided liver biopsy (EUS-bx) has been shown to be a safe and effective alternative to percutaneous or Interventional Radiology-guided liver biopsy for the diagnosis of chronic liver disease (CLD). We aimed to evaluate the correlation between PPG and clinical markers of PH, and assess the feasibility and safety of concomitant, single session EUS-PPG and EUS-bx.
This was a retrospective study of patients undergoing EUS-PPG for CLD at a single tertiary endoscopy center between February 2014 and March 2020. EUS-PPG was performed using a 25-gauge needle and compact manometer. Data analysis was performed with SAS version 9.4.
Eighty-three patients underwent EUS-PPG with 100% technical success. The mean PPG was 7.06 mmHg (SD 6.09, range 0-27.3). PPG was higher in patients with (vs without) clinical features of cirrhosis (9.46 vs 3.61 mmHg, P < 0.0001), esophageal or gastric varices (13.88 vs 4.34 mmHg, P < 0.0001), and thrombocytopenia (9.25 vs 4.71 mmHg, P = 0.0022). In the 71 patients (85.5%) who underwent EUS-bx, 70 (98.6%) specimens were deemed adequate by the pathologist for histologic diagnosis. There were no early or late major adverse events.
EUS-PPG correlates well with clinical markers of PH. EUS-bx can be performed safely during the same session as EUS-PPG, providing a comprehensive endoscopic evaluation of the patient with CLD.
门静脉压力梯度（PPG）是预测门静脉高压（PH）相关并发症的有用指标。我们之前已经证明了内镜超声引导 PPG 测量（EUS-PPG）的可行性和安全性。现在，内镜超声引导下肝活检（EUS-bx）已被证明是一种安全有效的替代经皮或介入放射学引导下肝活检的方法，用于诊断慢性肝病（CLD）。我们旨在评估 PPG 与 PH 的临床标志物之间的相关性，并评估同时进行的、单次 EUS-PPG 和 EUS-bx 的可行性和安全性。
这是一项在 2014 年 2 月至 2020 年 3 月期间在一家三级内镜中心接受 EUS-PPG 检查的 CLD 患者的回顾性研究。EUS-PPG 使用 25 号针和紧凑型压力计进行。数据分析使用 SAS 版本 9.4 进行。
83 例患者成功进行了 EUS-PPG，技术成功率为 100%。平均 PPG 为 7.06mmHg（SD 6.09，范围 0-27.3）。与无肝硬化（9.46 与 3.61mmHg，P<0.0001）、食管或胃静脉曲张（13.88 与 4.34mmHg，P<0.0001）和血小板减少症（9.25 与 4.71mmHg，P=0.0022）临床特征的患者相比，PPG 更高。在 71 例（85.5%）接受 EUS-bx 的患者中，70 例（98.6%）标本由病理学家认为足以进行组织学诊断。没有早期或晚期的主要不良事件。
EUS-PPG 与 PH 的临床标志物密切相关。EUS-bx 可以在与 EUS-PPG 相同的时间内安全进行，为 CLD 患者提供全面的内镜评估。
