Abstract Background Endoscopic ultrasound (EUS) has emerged as a valuable tool for assessing portal hypertension (PH). Our study aimed to compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with directly measured transjugular PPG (T-PPG) and hepatic venous pressure gradient (HVPG) during transjugular intrahepatic portosystemic shunt (TIPS). Methods Consecutive patients scheduled for elective TIPS between March 2023 and December 2024 were included. EUS was performed using a 22-gauge FNA needle attached to an invasive pressure monitoring module. TIPS placement and HVPG were performed according to the standard methods. Results Twenty-four patients who underwent elective TIPS for PH-related complications were enrolled (mean age 56.4 ± 8.8 years, model of end-stage liver disease MELD 15.0 ± 5.5). The technical success rates for EUS-PPG and HVPG were 92.3% and 100%, respectively. There was a strong correlation between EUS-PPG and T-PPG (r = 0.88, P 0.01; intra-class correlation coefficient ICC = 0.930, 95% CI 0.837–0.970) and a moderate correlation between EUS-PPG and HVPG (r = 0.58, P 0.05; ICC = 0.735, 95% CI 0.311–0.898). The presence of portal vein thrombosis (PVT) was independently associated with a ≥ 3 mmHg difference between EUS-PPG and T-PPG (P = 0.04). Child-Pugh score was independently associated with a ≥ 3 mmHg difference between EUS-PPG and HVPG (P = 0.01). Two minor adverse effects were reported. Conclusion EUS-PPG demonstrates strong reliability when compared to direct PPG measurements obtained during TIPS insertion. Using a 22-gauge needle, EUS-PPG proved to be accurate and safe for assessing PH. The presence of PVT may be a cofounder of discrepancy between the direct methods.
Dragomir et al. (Tue,) studied this question.