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The following is a summary of “Endoscopic Ultrasound Guided Portosystemic Pressure Gradient Correlates with Clinical Parameters and Liver Histology,” published in the January 2025 issue of Clinical Gastroenterology and Hepatology by Kolb et al.

Endoscopic ultrasound-guided portosystemic pressure gradient measurement (EUS-PPG) is an emerging diagnostic modality for assessing portal hypertension (PH), a condition critical for prognostication and therapeutic decision-making in patients with liver disease. This study aimed to evaluate the safety, technical feasibility, and diagnostic efficacy of EUS-PPG, as well as its correlation with clinical parameters and liver histology. Researchers conducted a multicenter, retrospective analysis of patients who underwent EUS-PPG between January 2020 and December 2022 across eight centers for suspected liver disease or PH. The relationship between EUS-PPG and established clinical markers of PH was examined using linear regression, while chi-square, Fisher’s exact, and Wilcoxon rank-sum tests assessed its correlation with liver biopsy findings and non-invasive fibrosis markers, including the Fibrosis-4 Index (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI).

Logistic regression was used to determine the most robust predictor of histologically confirmed cirrhosis. A total of 385 patients were included, with successful EUS-PPG measurements obtained in 373 cases (technical success rate: 97%). Patients with esophageal varices, portal hypertensive gastropathy, and thrombocytopenia exhibited significantly higher median PPG values (11.6 mmHg vs. 4.1 mmHg, 10.5 mmHg vs. 3.3 mmHg, and 7.6 mmHg vs. 4.4 mmHg, respectively; P<0.001 for all comparisons). Furthermore, patients with PH and clinically significant PH (PPG >10 mmHg) were 6.7 and 3.8 times more likely, respectively, to have histologically confirmed cirrhosis. 

Among all evaluated diagnostic tools, EUS-PPG demonstrated the highest predictive accuracy for cirrhosis (AUC=0.84), outperforming FIB-4 (AUC=0.72) and APRI (AUC=0.54). Adverse events were minimal, with only two cases of mild postprocedural pain reported. These findings establish EUS-PPG as a safe, technically feasible, and highly effective method for assessing PH. Moreover, EUS-PPG >5 mmHg emerged as the strongest predictor of histologic cirrhosis, surpassing conventional non-invasive fibrosis markers.

Source: cghjournal.org/article/S1542-3565(25)00078-3/abstract