Advances in portal pressure measurement: Endoscopic techniques, challenges, and implications for liver transplantation.

Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation. Traditional methods such as hepatic venous pressure gradient (HVPG) measurement have long been considered the gold standard for assessing portal pressure. However, these methods are invasive and carry procedural limitations. Recent advances in endoscopic ultrasound (EUS)-guided techniques have emerged as promising alternatives, offering direct and minimally invasive assessment of portal pressure. EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system. This technique has shown to be as accurate as HVPG, and it has some extra benefits, like the ability to take liver biopsies and check collateral circulation all at the same time. Despite these benefits, the technique poses challenges such as operator dependence, procedural complexity, and limited standardization across centres. This minireview highlights the evolution of portal pressure measurement, focusing on the potential of EUS-guided techniques in pre-transplant assessment, risk stratification, and monitoring therapeutic outcomes. Furthermore, it discusses the technical challenges, clinical implications, and future directions for integrating these innovations into routine practice. Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.