Prognostic Role of Endoscopic Ultrasound Guided Direct Portal Pressure Gradient Measurement in Porto‐Sinusoidal Vascular Disorder

ABSTRACT Background & Aims HVPG is the gold standard for the diagnosis of clinically significant portal hypertension (CSPH), a condition associated with the risk of developing hepatic decompensation events. However, HVPG is an indirect method to measure portal pressure, and its application in the pre‐sinusoidal form of portal hypertension (PH), as in porto‐sinusoidal vascular disorder (PSVD), is hindered by low accuracy. Recently, endoscopic ultrasound‐guided portal pressure gradient (EUS‐PPG) measurement, which allows direct measurement of portal pressure, is emerging as a safe method and may overcome the limitation of HVPG. However, data in patients with CSPH and the pre‐sinusoidal form of PH are still missing. This study aims to evaluate the safety and usefulness of EUS‐PPG compared to HVPG in a cohort of patients with PSVD and CSPH. Methods In this prospective single center study, patients with a diagnosis of PSVD who presented a clinical suspicion of CSPH underwent HVPG and EUS‐PPG baseline measurements. A second EUS‐PPG measurement was performed in patients naïve to non‐selective beta‐blockers (NSBBs) to evaluate haemodynamic response to therapy. Results Twenty‐six patients were enrolled and a total of 26 HVPG and 35 EUS‐PPG measurements were performed, without any adverse events. Mean EUS‐PPG was significantly higher than mean HVPG value (16.7 ± 5.5 mmHg versus 5.5 ± 2.8 mmHg). At logistic multivariate regression analysis, EUS‐PPG value was the only variable associated with hepatic decompensation. Conclusions EUS‐PPG measurement is safe and might have a prognostic role in patients with PSVD and CSPH, outperforming HVPG. Trial Registration ID5486