Ultrasound‐Guided Fine‐Needle vs. Transjugular Portal Pressure Measurements in Non‐Viral, Non‐Alcoholic Cirrhosis

BACKGROUND AND AIMS: Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension in patients with viral- and alcohol-related cirrhosis, but its accuracy is limited in other aetiologies. This study aimed to evaluate the correlation of portal venous pressure measurements in patients with non-alcoholic, non-viral-related decompensated cirrhosis, using fine-needle puncture (FN-PVP), direct portal vein catheterisation (D-PVP) and wedged hepatic vein balloon occlusion (WHVP). METHODS: ), intraclass correlation coefficient (ICC) and the Bland-Altman method were used to assess the correlation and consistency between the pressure measurements obtained by the different methods. RESULTS: : 0.302 vs. 0.87). In patients without intrahepatic venovenous shunts (IHVS), the correlation and consistency between WHVP and D-PVP showed slight improvement (r = 0.609, ICCa = 0.523, ICCc = 0.620). Using D-PPG as the benchmark, FN-PPG demonstrated excellent classification accuracy, significantly outperforming HVPG. CONCLUSION: In patients with non-alcoholic, non-viral-related PHT, HVPG may underestimate the true PPG, regardless of the presence of IHVS. In contrast, FN-PVP can safely and accurately reflect portal pressure and serves as an effective alternative for direct portal pressure measurement.