Within-Session Repeatability of EUS-Guided Portal Pressure Gradient Measurement (REPEAT-PPG)

November 12, 2026 updated by: Prof. Dr. Michael Praktiknjo, University Hospital Muenster

Within-Session Repeatability and Inter-Operator Reproducibility of EUS-Guided Portal Pressure Gradient Measurement: A Prospective Multicentre Study

This prospective multicentre observational reliability study will determine how much a repeated endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement differs from the first measurement in the same patient during the same procedural session. Each participant will undergo two complete EUS-PPG measurement sets using an identical 22-gauge measurement setup. The study will quantify within-session repeatability when the same expert performs both sets and inter-operator reproducibility when different operators perform the sets.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Consecutive adults with an independently established clinical indication for EUS-PPG will be enrolled at five centres. The clinically indicated first measurement will be followed by a research-only second complete measurement set during the same sedation episode, without an intervention between sets. After the first set, the system will be flushed, the needle withdrawn from the liver, the system recalibrated, and the portal and hepatic veins punctured again for fresh triplicate readings. The interval between sets is targeted at 10 minutes or less. Two techniques of withdrawal are allowed. One technique includes transcapsular re-puncture. The needle is flushed and fully retracted from the liver. The other technique includes subcapsular retraction. The needle is flushed and withdrawn into the liver parenchyma to a position immediately beneath the capsule, without crossing it, so that no further capsular puncture is performed. Procedure lists will be cluster-randomised according to examination lists to one of three operator configurations: the same expert performs both sets, two different experts perform the sets, or an expert and a trainee under supervision perform the sets. The order within each pair will be randomised. Clinical decisions will be based exclusively on the first measurement set. Participants will undergo safety follow-up through day 30.

Study Type

Observational

Enrollment (Estimated)

150

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Belgium
      • Leuven, Belgium
        • UZ Leuven
        • Contact:
          • Wim Laleman, MD PhD
  • Canada
    • Quebec
      • Montreal, Quebec, Canada
        • McGill University Health Centre
        • Contact:
          • Amine Benmassaoud, MD
      • Montreal, Quebec, Canada
        • Centre hospitalier de l'Université de Montréal (CHUM)
        • Contact:
          • Philippe Willems, MD
  • Germany
    • North Rhine-Westphalia
      • Münster, North Rhine-Westphalia, Germany, 48149
  • Italy
    • Lazio
      • Rome, Lazio, Italy, 00168
        • Fondazione Policlinico Universitario Agostino Gemelli IRCCS
        • Contact:
          • Francesco Santoapolo, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Consecutive adult patients with an independently established clinical indication for EUS-guided portal pressure gradient measurement, including patients with and without clinically significant portal hypertension.

Description

Inclusion Criteria:

  • Age 18 years or older
  • Clinical indication for EUS-guided portal pressure gradient measurement established independently of the study
  • Written informed consent, including consent for the additional measurement set

Exclusion Criteria:

  • Contraindication to endoscopy, sedation, or endosonography-guided vascular puncture
  • Non-correctable coagulation disorder
  • Hemodynamic instability at the time of the procedure
  • Any intervention between the two measurement sets that may alter portal pressure, including fluid administration beyond maintenance requirements, vasoactive substances, paracentesis, or variceal band ligation
  • Technically non-evaluable first measurement set
  • Pregnancy or breastfeeding
  • Inability to provide informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: COHORT
  • Time Perspectives: PROSPECTIVE

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Same expert operator

Both complete measurement sets are performed by the same expert operator.
Diagnostic test: Repeated EUS-Guided Portal Pressure Gradient Measurement

During a clinically indicated EUS-PPG procedure, each participant undergoes a second complete EUS-PPG measurement set in the same session. For each set, pressures in a hepatic vein and an intrahepatic portal vein branch are measured in triplicate using the same 22-gauge measurement chain. Before the repeat set, the system is flushed, the needle is withdrawn with one of the allowed techniques, the transducer is recalibrated, and the target vessels are independently re-identified and punctured. No treatment or portal-pressure-altering intervention occurs between the two sets.
Two expert operators

The two complete measurement sets are performed by two different expert operators, with order randomised.
Diagnostic test: Repeated EUS-Guided Portal Pressure Gradient Measurement

During a clinically indicated EUS-PPG procedure, each participant undergoes a second complete EUS-PPG measurement set in the same session. For each set, pressures in a hepatic vein and an intrahepatic portal vein branch are measured in triplicate using the same 22-gauge measurement chain. Before the repeat set, the system is flushed, the needle is withdrawn with one of the allowed techniques, the transducer is recalibrated, and the target vessels are independently re-identified and punctured. No treatment or portal-pressure-altering intervention occurs between the two sets.
Expert and trainee operators

One complete measurement set is performed by an expert and the other by a trainee under direct supervision, with order randomised.
Diagnostic test: Repeated EUS-Guided Portal Pressure Gradient Measurement

During a clinically indicated EUS-PPG procedure, each participant undergoes a second complete EUS-PPG measurement set in the same session. For each set, pressures in a hepatic vein and an intrahepatic portal vein branch are measured in triplicate using the same 22-gauge measurement chain. Before the repeat set, the system is flushed, the needle is withdrawn with one of the allowed techniques, the transducer is recalibrated, and the target vessels are independently re-identified and punctured. No treatment or portal-pressure-altering intervention occurs between the two sets.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Within-session repeatability coefficient of EUS-PPG measured by the same expert operator
Time Frame: During the index EUS-PPG procedure

The repeatability coefficient will be calculated as 2.77 multiplied by the within-subject standard deviation of paired EUS-PPG measurements in the same-expert group. It will be reported in mmHg and as a percentage of the cohort mean, with a 95% confidence interval.
During the index EUS-PPG procedure

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Inter-operator reproducibility coefficient of EUS-PPG
Time Frame: During the index EUS-PPG procedure

The reproducibility coefficient will be estimated from paired EUS-PPG differences when different operators perform the two measurement sets and will be reported in mmHg and as a percentage, with a 95% confidence interval.
During the index EUS-PPG procedure
Variance components of repeated EUS-PPG measurements
Time Frame: During the index EUS-PPG procedure

A mixed-effects model using all individual readings will estimate patient-, procedure-list-, operator-, measurement-set-, and reading-level variance components.
During the index EUS-PPG procedure
Intraclass correlation coefficient for paired EUS-PPG measurements
Time Frame: During the index EUS-PPG procedure

Two-way absolute-agreement intraclass correlation coefficients will be reported overall and by operator configuration with 95% confidence intervals.
During the index EUS-PPG procedure
Bland-Altman agreement of paired EUS-PPG measurements
Time Frame: During the index EUS-PPG procedure

Bias and 95% limits of agreement will be calculated overall and separately by operator pairing.
During the index EUS-PPG procedure
Discordant classification at portal pressure gradient thresholds of 10 mmHg and 12 mmHg
Time Frame: During the index EUS-PPG procedure

The proportion of participants whose classification crosses the 10-mmHg or 12-mmHg threshold between the two measurement sets will be reported.
During the index EUS-PPG procedure
Procedure-associated adverse events
Time Frame: From the index procedure through 30 days

Adverse events will include bleeding, pain, hemoglobin decrease, sedation-related events, unplanned admission or prolongation of stay, transfusion, and unplanned intervention.
From the index procedure through 30 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University Hospital Muenster

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 1, 2027

Primary Completion (Estimated)

July 1, 2028

Study Completion (Estimated)

October 1, 2028

Study Registration Dates

First Submitted

October 8, 2026

First Submitted That Met QC Criteria

October 8, 2026

First Posted (Actual)

October 16, 2026

Study Record Updates

Last Update Posted (Actual)

November 13, 2026

Last Update Submitted That Met QC Criteria

November 12, 2026

Last Verified

November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REPEAT-PPG

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Subscribe