eus-guided portal pressure gradient (ppg) measurement: a potential alternative to the traditional hvpg

Conditions: Portal Hypertension; Chronic Liver Disease (CLD); Cirrhosis

Summary: the goal of this investigator-initiated, single-arm, prospective study is to evaluate the accuracy, safety, and feasibility of endoscopic ultrasound-guided portal pressure gradient (eus-ppg) measurement as a potential alternative to the traditional hepatic venous pressure gradient (hvpg) method in patients with portal hypertension due to chronic liver disease. the main questions it aims to answer are: * what is the correlation between eus-ppg and hvpg measurements in patients with portal hypertension due to cirrhosis? * can eus-ppg serve as a reliable and less invasive alternative to hvpg for assessing portal pressure? * what are the safety outcomes associated with eus-ppg compared to hvpg? researchers will compare eus-ppg measurements with hvpg measurements within the same patients to assess whether eus-ppg provides accurate and clinically comparable portal pressure readings while reducing procedural risks. participants will: * be adults aged 18 to 85 with a history of liver disease and portal hypertension or suspected cirrhosis requiring hvpg measurement. * undergo both eus-ppg and hvpg measurements within a seven-day window to allow for direct comparison of results. * receive standard clinical care for their condition, including routine diagnostic evaluations and portal hypertension management as needed. * be monitored for safety outcomes, including adverse events such as bleeding, infection, perforation, and any other complications related to the procedure. * provide relevant demographic and clinical data, including liver disease history, child-pugh and meld scores, and portal hypertension-related complications such as varices or ascites.


Eligibility criteria:
inclusion criteria: * subjects must be 18 to 85 years of age inclusive, at the time of signing the informed consent form. * subjects who have a history of liver disease and portal hypertension or suspected cirrhosis requiring hvpg measurement. * subjects capable of giving signed informed consent. exclusion criteria: * pregnancy. * significant bleeding risk (international normalized ratio (inr) \> 1.5 or platelet count \< 50000). * presence of active gastrointestinal bleeding at the time of screening * history of any blood thinner consumption (e.g. warfarin, heparin, novel roal anticoagulants) within the last 5 days. * presence of massive ascites causing abdominal distension or requiring frequent therapeutic paracentesis. * subjects having received previous transjugular intrahepatic portosystemic shunt (tips) or surgical portosystemic shunt. * hepatocellular carcinoma not meeting milan criteria. * presence of portal vein thrombosis or another suspected component of presinusoidal portal hypertension. * presence of extra-hepatic cancer, terminal disease, or severe comorbidities significantly limiting life expectancy or affecting study participation. * stenosis or surgical anatomical alterations of the gastrointestinal tract that could preclude endoscopic access with the echoendoscope.

Keywords: hepatic venous pressure gradient endoscopic ultrasound-guided portal pressure gradient portal hypertension non-invasive diagnostic methods for portal hypertension