Measuring the portal pressure gradient can assist in the management of patients with suspected or known liver disease. Understanding a patient’s portal pressure gradient can help predict complications such as: variceal bleeding, ascites, encephalopathy, and perioperative mortality. Traditionally, interventional radiologists have measured the portal pressure gradient during a transjugular liver biopsy. EUS-guided liver biopsy has been proven to be an effective and safe alternative to percutaneous transhepatic and transjugular liver biopsy. A novel endoscopic device allows for EUS-guided portal pressure gradient measurement (EUS-PPGM). To assess the safety of combining EUS-PPGM and liver biopsy during a single endoscopic procedure. EUS-PPGM with liver biopsy was performed on 38 patients at our institution between June 2014 and May 2017. All procedures were performed by one of two experienced endoscopists (JS and KC). Pre-procedural data collected included: etiology of cirrhosis, liver function testing, and complications of cirrhosis (e.g., varices, ascites, encephalopathy). During the procedure, portal pressure gradients and biopsy specimen data was collected. Post-procedure, all patients were monitored for complications including pain, nausea, vomiting, bleeding, infection, or admission to hospital. There were 38 patients included in the analysis. A satisfactory portal pressure gradient measurement and liver biopsy specimen was achieved during every procedure. There were 35 patients (92%) who were Child-Pugh class A, while the remaining 3 patients (8%) were Child-Pugh class B. On average, the platelet count was 165 (range 88-377) and INR was 1.1 (range 0.9-1.6). The average gradient was 7.3 mmHg (range 0 – 27.3mmHg). While 18 patients (47%) had evidence of portal hypertension (gradient >5mmHg) only 12 patients (32%) had clinically significant portal hypertension (gradient ≥10). There were no serious complications from any procedures. 2 patients (5%) developed pain and nausea that were managed using oral pain medication and anti-emetics. No patients developed signs bleeding or infection. No patients required admission to hospital as a result of the procedure. EUS-PPGM combined with liver biopsy in a single endoscopic procedure may be safely performed in patients with Child-Pugh A and B cirrhosis. This combined procedure offers a novel substitute to transjugular liver biopsies with portal pressure gradient measurement.