Endoscopic Ultrasound-Guided Portal Pressure Measurement and Interventions

Jason B Samarasena, Kenneth J Chang, Jason B Samarasena, Kenneth J Chang

Abstract

A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization. Potential clinical applications of EUS-guided portal venous access include angiography, measurement of the portosystemic pressure gradient, EUS-guided transhepatic intrahepatic portosystemic shunt creation and portal vein sampling for the evaluation in gastrointestinal cancer. The following article reviews the different devices and techniques employed in these applications.

Keywords: Hepatic venous portal gradient; Portal pressure gradient; Portal vein sampling; Transhepatic intrahepatic portosystemic shunt; Endosonography.

Conflict of interest statement

Conflicts of Interest:The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Compact manometer used for endoscopic ultrasound-guided portal pressure measurement (Cook Medical, Bloomington, IN, USA).
Fig. 2.
Fig. 2.
Endoscopic ultrasound-guided portal pressure measurement apparatus showing non-compressible tubing attached to the fine needle aspiration needle inlet (right pane) and compact manometer being placed at the mid-axillary line of the patient (left pane).
Fig. 3.
Fig. 3.
Endoscopic ultrasound image of needle puncture of middle hepatic vein with 25 G fine needle aspiration needle.
Fig. 4.
Fig. 4.
Endoscopic ultrasound Doppler flow image of middle hepatic vein demonstrating multiphasic waveform.
Fig. 5.
Fig. 5.
Endoscopic ultrasound image of needle puncture of left portal vein with 25 G fine needle aspiration needle.
Fig. 6.
Fig. 6.
Endoscopic ultrasound Doppler flow image of left portal vein demonstrating typical waveform.

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