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

Risk stratification in liver disease includes liver elastography (LE) and portal pressure gradient (PPG) measurement. 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. This is a prospective and retrospective, single-center study. 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. 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. 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.