Gastroenterology report · 2026
Endoscopic ultrasound versus direct transjugular portal pressure gradient in patients receiving TIPS: influence of portal vein thrombosis.
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Dragomir Irina, Pojoga Cristina, Hagiu Claudia, Bolboacă Sorana D, Alexa Alexandru, Nicoara-Farcau Oana, Fischer Petra, Stefanescu Horia, Procopet Bogdan, Seicean Andrada
Аннотация
BACKGROUND: Endoscopic ultrasound (EUS) has emerged as a valuable tool for assessing portal hypertension (PH). Our study aimed to compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with directly measured transjugular PPG (T-PPG) and hepatic venous pressure gradient (HVPG) during transjugular intrahepatic portosystemic shunt (TIPS).
METHODS: Consecutive patients scheduled for elective TIPS between March 2023 and December 2024 were included. EUS was performed using a 22-gauge FNA needle attached to an invasive pressure monitoring module. TIPS placement and HVPG were performed according to the standard methods.
RESULTS: Twenty-four patients who underwent elective TIPS for PH-related complications were enrolled (mean age 56.4 ± 8.8 years, model of end-stage liver disease [MELD] 15.0 ± 5.5). The technical success rates for EUS-PPG and HVPG were 92.3% and 100%, respectively. There was a strong correlation between EUS-PPG and T-PPG (r = 0.88, P < 0.01; intra-class correlation coefficient [ICC] = 0.930, 95% CI 0.837-0.970) and a moderate correlation between EUS-PPG and HVPG (r = 0.58, P < 0.05; ICC = 0.735, 95% CI 0.311-0.898). The presence of portal vein thrombosis (PVT) was independently associated with a ≥ 3 mmHg difference between EUS-PPG and T-PPG (P = 0.04). Child-Pugh score was independently associated with a ≥ 3 mmHg difference between EUS-PPG and HVPG (P = 0.01). Two minor adverse effects were reported.
CONCLUSION: EUS-PPG demonstrates strong reliability when compared to direct PPG measurements obtained during TIPS insertion. Using a 22-gauge needle, EUS-PPG proved to be accurate and safe for assessing PH. The presence of PVT may be a cofounder of discrepancy between the direct methods.
METHODS: Consecutive patients scheduled for elective TIPS between March 2023 and December 2024 were included. EUS was performed using a 22-gauge FNA needle attached to an invasive pressure monitoring module. TIPS placement and HVPG were performed according to the standard methods.
RESULTS: Twenty-four patients who underwent elective TIPS for PH-related complications were enrolled (mean age 56.4 ± 8.8 years, model of end-stage liver disease [MELD] 15.0 ± 5.5). The technical success rates for EUS-PPG and HVPG were 92.3% and 100%, respectively. There was a strong correlation between EUS-PPG and T-PPG (r = 0.88, P < 0.01; intra-class correlation coefficient [ICC] = 0.930, 95% CI 0.837-0.970) and a moderate correlation between EUS-PPG and HVPG (r = 0.58, P < 0.05; ICC = 0.735, 95% CI 0.311-0.898). The presence of portal vein thrombosis (PVT) was independently associated with a ≥ 3 mmHg difference between EUS-PPG and T-PPG (P = 0.04). Child-Pugh score was independently associated with a ≥ 3 mmHg difference between EUS-PPG and HVPG (P = 0.01). Two minor adverse effects were reported.
CONCLUSION: EUS-PPG demonstrates strong reliability when compared to direct PPG measurements obtained during TIPS insertion. Using a 22-gauge needle, EUS-PPG proved to be accurate and safe for assessing PH. The presence of PVT may be a cofounder of discrepancy between the direct methods.