The application of EUS-guided portal pressure gradient measurement with concomitant EUS-liver elastography and EUS-guided liver biopsy in patients with chronic liver disease: a single center experience

Background: Risk stratification in liver disease includes liver elastography (LE) and portal pressure gradient (PPG) measurement. Objectives: We examined the efficacy and safety of endoscopic ultrasound (EUS)-liver biopsy (EUS-LB) and the correlation between EUS-PPG and EUS-LE in patients with liver...

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Main Authors: Muhammad Nadeem Yousaf, Ahmad Hassan Ali, Sohum A. Patwa, Sanket Basida, Nicholas McGee, Jacob Cebulko, Darian Fard, Alexander Malik, Xheni Deda, Ghassan M. Hammoud
Format: Article
Language:English
Published: SAGE Publishing 2025-07-01
Series:Therapeutic Advances in Gastroenterology
Online Access:https://doi.org/10.1177/17562848251359015
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Summary:Background: Risk stratification in liver disease includes liver elastography (LE) and portal pressure gradient (PPG) measurement. Objectives: We examined the efficacy and safety of endoscopic ultrasound (EUS)-liver biopsy (EUS-LB) and the correlation between EUS-PPG and EUS-LE in patients with liver disease. Study design: This is a prospective and retrospective, single-center study. Methods: Data from patients who underwent concomitant EUS-LE, EUS-PPG, and EUS-LB were analyzed. Histologically, significant fibrosis (SF) was considered F2–F4, non-significant fibrosis (NSF) as F0–F1, advanced fibrosis (AF) as F3–F4, and non-advanced fibrosis (NAF) as F0–F2. Results: In total, 25 patients underwent EUS-PPG measurement; 60% were male (mean age, 60 years). EUS-LE and EUS-LB were performed in 88% and 96% of patients, respectively (the technical success rate was 100%). The mean number of portal tracts was 14.3. Histological diagnosis was achieved in all patients; 67% had SF. The mean EUS-LE was 24.1 kPa, and the mean PPG was 4.6 mmHg. Portal hypertension (PH; PPG >5 mmHg) and clinically significant PH (PPG >10 mmHg) were found in 44% and 12%, respectively. Patients with SF had a higher mean PPG (5.9 vs 2.8 mmHg; p  = 0.003) and mean shear wave measurement (SWM; 30.0 vs 15.6 kPa; p  = 0.02) compared to the NSF group. Patients with AF had a higher mean PPG (6.0 vs 3.4 mmHg; p  = 0.01) and mean SWM (32.0 vs 18.8 kPa; p  = 0.04) compared to the NAF group. There were no significant adverse events. Conclusion: Concomitant EUS-LB and PPG is safe. EUS-PPG and EUS-LE correlate with the degree of fibrosis on histology. Larger studies are needed to optimize their values in clinical practice.
ISSN:1756-2848