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

12. november 2026 opdateret af: 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.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

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 After the first set, the system will be flushed, the needle withdrawn from the liver, the system recalibrated, and the portal and hepatic veins punctured again for fresh triplicate readings.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 The needle is flushed and withdrawn into the liver parenchyma to a position immediately beneath the capsule, without crossing it, so that no further capsular puncture is performed.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.

Undersøgelsestype

Observationel

Tilmelding (Anslået)

150

Kontakter og lokationer

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Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

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

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

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.

Beskrivelse

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

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Observationsmodeller: COHORT
  • Tidsperspektiver: PROSPECTIVE

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Same expert operator

Both complete measurement sets are performed by the same expert operator.

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.

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.

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.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Within-session repeatability coefficient of EUS-PPG measured by the same expert operator
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Inter-operator reproducibility coefficient of EUS-PPG
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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

Samarbejdspartnere og efterforskere

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Sponsor

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

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Studer store datoer

Studiestart (Anslået)

1. januar 2027

Primær færdiggørelse (Anslået)

1. juli 2028

Studieafslutning (Anslået)

1. oktober 2028

Datoer for studieregistrering

Først indsendt

8. oktober 2026

Først indsendt, der opfyldte QC-kriterier

8. oktober 2026

Først opslået (Faktiske)

16. oktober 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

13. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

12. november 2026

Sidst verificeret

1. november 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • REPEAT-PPG

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