Utility of minimally invasive measurement of hepatic venous pressure gradient via the peripheral antecubital vein

We read with great interest the three articles by Bosch,1 Tripathi,2 and Monteiro.3 In those articles, measurement of hepatic venous pressure gradient (HVPG) played a key role in assessing the portal hypertension in patients with advanced liver disease. One obstacle to examining portal hypertension in clinical trials with suitably large cohorts is the substantial barrier to repeated measurement of HVPG. HVPG measurement is performed using a balloon catheter, most frequently inserted from the jugular vein. HVPG measurement is considered to require specific expertise and around a day of hospitalisation, making the procedure relatively expensive and burdensome.4 5 Despite many attempts, non-invasive methods have not yet been able to completely replace direct HVPG measurement.5 6 Here, we report a study on the methods for HVPG measurement from the peripheral antecubital vein (pHVPG). Although this method has been mentioned in a review of HVPG measurement, no detailed descriptions of this approach have been published.4 Forty-one measurements from 37 consecutive patients who …