665 EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT SAFELY PERFORMED WITH EUS-GUIDED LIVER BIOPSY: ENDOHEPATOLOGY IN PRACTICE

Abstract

The portal pressure gradient (PPG) is useful to predict the development of complications of portal hypertension (PH). Recently, we showed the feasibility and safety of a simple novel technique for Endoscopic ultrasound (EUS) guided PPG measurement (PPGM) in a pilot study. EUS-guided liver biopsy (EUS-LB) has been shown to be a safe and effective alternative to percutaneously or Interventional Radiology performed liver biopsy for the diagnosis of liver disease. We aimed to assess feasibility and safety of concomitant EUS-guided PPGM with EUS-LB in a single session. Secondarily, we aimed to evaluate the correlation between PPG and clinical markers of PH in an expanded clinical series. This was a retrospective study of EUS-PPGM at single tertiary endoscopy center that enrolled 76 consecutive patients suspected of liver cirrhosis between February 2014 and October 2019. Technical success rate of EUS-PPGM was 100% without any severe adverse events. PPG ranged from 0 to 27.3 mm Hg. There was excellent correlation between PPG and clinical parameters of PH including the presence of clinical features of cirrhosis (11.12 vs 3.55 mmHg, p < 0.001), varices (14.01 vs 4.7 mmHg, p <0.001), portal hypertensive gastropathy (16.37 vs 5.87 mmHg, p < 0.001), and thrombocytopenia (11.1 vs 4.51 mmHg, p < 0.01). Platelet count also had a moderate negative correlation with PPG (R = –0.579). EUS-guided liver biopsies were performed in 61 patients (80.2%). All biopsies were deemed adequate for achieving histologic diagnosis by our pathologists. There were no early or late major adverse events. This series is the largest on EUS guided portal pressure measurement to date. EUS-guided PPG measurement using a 25-gauge needle and compact manometer correlates well with clinical markers of portal hypertension and appears safe in this study with an expanded selection of patients. EUS-LB can be performed safely at the same session as EUS-PPGM further adding value to the endoscopic evaluation of the patient with liver disease.