Kolb Jennifer M, Monachese Marc, Rubin Raymond A, Wang Thomas J, Choi Alyssa, Bazarbashi Ahmad N, Brahmbhatt Bhaumik, Zakaria Ali, Cortes Pedro, Kesar Varun, Abel William F, Chen Wen-Pin, McLaren Christine, Tavangar Amirali, Singal Amit G, Taunk Pushpak, Wallace Michael B, Kedia Prashant, Lee David, Abbas Ali, Yeaton Paul, Cosgrove Natalie, Kesar Vivek, Chang Kenneth J, Ryou Marvin, Samarasena Jason
Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California.
Clin Gastroenterol Hepatol. 2025 Jan 30. doi: 10.1016/j.cgh.2024.12.022.
Endoscopic ultrasound-guided portosystemic pressure gradient measurement (EUS-PPG) is a novel technique to evaluate for portal hypertension (PH), a diagnosis that can prognosticate and guide therapy for patients. This study evaluated the safety and efficacy of EUS-PPG and correlation with clinical parameters and liver histology.
We conducted a multicenter, retrospective study of patients undergoing EUS-PPG from January 2020 to December 2022 for suspected liver disease or PH. Linear regression was used to examine the relationship between EUS-PPG and clinical parameters of PH, and the chi-square test, Fisher's exact test, and Wilcoxon rank sum test described correlation with liver biopsy histology and noninvasive markers of fibrosis (Fibrosis-4, APRI [aspartate aminotransferase-to-platelet ratio index]). Logistic regression was performed to identify the strongest predictor of histologic cirrhosis.
Across 8 centers, 385 patients were enrolled and 373 had successful EUS-PPG (technical success 97%). Higher median PPGs were observed in patients with than without esophageal varices (11.6 mm Hg vs 4.1 mm Hg), portal hypertensive gastropathy (10.5 mm Hg vs 3.3 mm Hg), and thrombocytopenia (7.6 mm Hg vs 4.4 mm Hg) (P < .001). Individuals with PH and clinically significant PH (PPG ≥10) were 6.7 and 3.8 times more likely to have cirrhosis on histology, respectively. EUS-PPG was the best overall predictor of biopsy-proven cirrhosis (area under the curve 0.84) compared with Fibrosis-4 (0.72), and APRI (0.54). There were 2 minor adverse events related to PPG (postprocedural pain).
EUS-PPG measurement was technically feasible and safe and demonstrated a strong correlation with clinical parameters of PH and liver histology. The strongest predictor of cirrhosis was EUS-PPG >5 mm Hg, which outperformed noninvasive markers of fibrosis.
内镜超声引导下门体静脉压力梯度测量（EUS-PPG）是一种评估门静脉高压（PH）的新技术，该诊断可为患者的预后及治疗提供指导。本研究评估了EUS-PPG的安全性和有效性以及与临床参数和肝脏组织学的相关性。
我们对2020年1月至2022年12月因疑似肝病或PH接受EUS-PPG检查的患者进行了一项多中心回顾性研究。采用线性回归分析EUS-PPG与PH临床参数之间的关系，采用卡方检验、Fisher精确检验和Wilcoxon秩和检验描述与肝活检组织学及纤维化无创标志物（Fibrosis-4、APRI[天冬氨酸转氨酶与血小板比值指数]）的相关性。进行逻辑回归分析以确定组织学肝硬化的最强预测因素。
在8个中心，共纳入385例患者，373例成功完成EUS-PPG测量（技术成功率97%）。有食管静脉曲张的患者比无食管静脉曲张的患者中位PPG更高（11.6 mmHg对4.1 mmHg），有门静脉高压性胃病的患者比无门静脉高压性胃病的患者中位PPG更高（10.5 mmHg对3.3 mmHg），有血小板减少症的患者比无血小板减少症的患者中位PPG更高（7.6 mmHg对4.4 mmHg）（P< .001）。PH患者和具有临床意义的PH患者（PPG≥10）肝组织学检查显示肝硬化的可能性分别是前者的6.7倍和3.8倍。与Fibrosis-4（0.72）和APRI（0.54）相比，EUS-PPG是活检证实肝硬化的最佳总体预测指标（曲线下面积0.84）。有2例与PPG相关的轻微不良事件（术后疼痛）。
EUS-PPG测量在技术上可行且安全，与PH临床参数和肝脏组织学密切相关。肝硬化的最强预测因素是EUS-PPG>5 mmHg，其优于纤维化无创标志物。
