Inclusion Criteria:  Age above 18 years Undergoing evaluation for chronic liver disease or portal hypertension Planned to undergo a liver biopsy and HVPG by their treating hepatologist for clinical purposes Signed informed consent  Exclusion Criteria:  Uncorrectable coagulopathy (INR above 1.5) Uncorrectable thrombocytopenia (Platelets under 50,000) Anticoagulation or antiplatelet therapy that cannot be discontinued Surgically altered upper digestive anatomy Biliary obstruction Grade II ascites or more Intrahepatic portal vein thrombosis Previous liver transplantation Past hypersensitivity reaction to midazolam or ketamine History of psychotic disorder Pregnancy