EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study

Jason B Samarasena, Jason Y Huang, Takeshi Tsujino, Daniel Thieu, Allen Yu, Ke-Qin Hu, John Lee, Kenneth J Chang, Jason B Samarasena, Jason Y Huang, Takeshi Tsujino, Daniel Thieu, Allen Yu, Ke-Qin Hu, John Lee, Kenneth J Chang

Abstract

Background and aims: Portal hypertension is a serious adverse event of liver cirrhosis. Recently, we developed a simple novel technique for EUS-guided portal pressure gradient (PPG) measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and interventional radiology-acquired PPGM. In this video we demonstrate the results of the first human pilot study of EUS-PPGM in patients with liver disease.

Methods: EUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge FNA needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted by use of a transgastric or transduodenal approach. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview.

Results: Twenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19 mm Hg and had excellent correlation with clinical parameters of portal hypertension, including the presence of varices (P = .0002), PH gastropathy (P = .007), and thrombocytopenia (P = .036).

Conclusion: This novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease.

Keywords: HV, hepatic vein; HVPG, HV pressure gradient; PH, portal hypertension; PPG, portal pressure gradient; PPGM, PPG measurement; PV, portal vein; WHVP, wedged HV pressure.

Figures

Figure 1
Figure 1
Compact manometer.
Figure 2
Figure 2
A, EUS image of transgastric transhepatic needle puncture into the portal vein with a 25-gauge FNA needle. B, Representation of EUS-guided transgastric portal vein puncture.
Figure 3
Figure 3
A, EUS image of transgastric transhepatic needle puncture into the hepatic vein with a 25-gauge FNA needle. B, Representation of EUS-guided transgastric hepatic vein puncture.

References

    1. Thalheimer U., Bellis L., Puoti C. Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. Eur J Intern Med. 2011;22:5–7.
    1. Sanyal A.J., Bosch J., Blei A. Portal hypertension and its complications. Gastroenterology. 2008;134:1715–1728.
    1. Burroughs A.K., McCormick P.A. Natural history and prognosis of variceal bleeding. Baillieres Clin Gastroenterol. 1992;6:437–450.
    1. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231.
    1. Armonis A., Patch D., Burroughs A. Hepatic venous pressure measurement: an old test as a new prognostic marker in cirrhosis? Hepatology. 1997;25:245–248.
    1. Groszmann R.J. Reassessing portal venous pressure measurements. Gastroenterology. 1984;86:1611–1614.
    1. Huang J.Y., Samarasena J.B., Tsujino T. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus the standard transjugular approach: a comparison animal study. Gastrointest Endosc. 2016;84:358–362.
    1. Huang J.Y., Samarasena J.B., Tsujino T. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc. 2017;85:996–1001.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다