EUS-guided portal pressure gradient measurement: a promising tool in noncirrhotic portal hypertension

Abstract

We have read the study by Zhang et al1Zhang W, Peng C, Zhang S, et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension. Gastrointest Endosc. Epub 2020 Jun 29.Google Scholar with great interest. They intended to study the correlation between EUS-guided portal pressure gradient (PPG) and hepatic venous pressure gradient (HVPG) in postsinusoidal and posthepatic portal pressure patients. Meanwhile, the subjects of this research should be discussed further. The result1Zhang W, Peng C, Zhang S, et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension. Gastrointest Endosc. Epub 2020 Jun 29.Google Scholar indirectly proved the high consistency of HVPG and PPG in patients with veno-occlusive disease (R=0.923). Unfortunately, because of the inability to perform HVPG measurements, 2 patients with Budd-Chiari syndrome (BCS) were not included in the final study.1Zhang W, Peng C, Zhang S, et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension. Gastrointest Endosc. Epub 2020 Jun 29.Google Scholar As for BCS, however, we still do not rule out the possibility of differences in the consistency of HVPG and PPG. The transmission of pressure in the liver sinusoids could be blocked by the stenosis of the hepatic veins, and the HVPG may be normal or elevated.2Khanna R. Sarin S.K. Non-cirrhotic portal hypertension: diagnosis and management.J Hepatol. 2014; 60: 421-441Abstract Full Text Full Text PDF PubMed Scopus (170) Google Scholar Therefore, for patients with BCS, especially those with presinusoidal portal hypertension,3Merkel C. Montagnese S. Hepatic venous pressure gradient measurement in clinical hepatology.Dig Liver Dis. 2011; 43: 762-767Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar HVPG may not be a reference standard of portal pressure. Although it did not affect the results of the study, we believe that it is inappropriate to include the BCS patients at the beginning. Therefore, direct measurement of portal pressure may be more meaningful in clinical practice.4Bissonnette J. Généreux A. Côté J. et al.Hepatic hemodynamics in 24 patients with nodular regenerative hyperplasia and symptomatic portal hypertension.J Gastroenterol Hepatol. 2012; 27: 1336-1340Crossref PubMed Scopus (26) Google Scholar,5Sorensen M. Larsen L.P. Villadsen G.E. et al.Beta-blockers improve presinusoidal portal hypertension.Dig Dis Sci. 2018; 63: 3153-3157Crossref PubMed Scopus (3) Google Scholar Given that it is better than the standard percutaneous approach, this method, guided by EUS, has been confirmed to be safer and easier in human studies.6Samarasena J.B. Chang K.J. Endoscopic ultrasound-guided interventions for the measurement and treatment of portal hypertension.Gastrointest Endosc Clin N Am. 2019; 29: 311-320Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Thus, it would convey special clinical value in assessing the portal pressure of patients with noncirrhotic portal hypertension (NCPH). Although this method is promising, there are still some uncertainties. For example, esophageal and ectopic varices are more common and severe in NCPH.7Sarin S.K. Lahoti D. Saxena S.P. et al.Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients.Hepatology. 1992; 16: 1343-1349Crossref PubMed Scopus (776) Google Scholar The puncture site, therefore, should be carefully chosen to avoid the submucous varices. Moreover, extrahepatic portal vein obstruction may diminish the utility of this method. Therefore, this promising approach needs further validation in NCPH. All authors disclosed no financial relationships. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertensionGastrointestinal EndoscopyVol. 93Issue 3PreviewEUS-guided portal pressure gradient (EUS-PPG) measurement is a novel method to evaluate portal hypertension severity. In this study, we determined the consistency between EUS-PPG and hepatic venous pressure gradient (HVPG) measurements in patients with acute or subacute portal hypertension. Full-Text PDF ResponseGastrointestinal EndoscopyVol. 93Issue 1PreviewWe appreciate Drs Xu and Ding1 for their interest and comments on our recent publication “EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension.”2 Full-Text PDF