Correlating EUS-guided Portosystemic Pressure Gradient measurement (EUS-PPG) with Shear Wave Elastography (SWE) and liver fibrosis to improve portal hypertension diagnosis

Aims Aim of our study was to evaluate the correlation between EUS–guided portosystemic pressure gradient measurement (EUS-PPG) and EUS-guided shear wave elastography (EUS-SWE) with histological liver fibrosis (LF) in patients with suspected clinically significant portal hypertension (CSPH). Methods This prospective, descriptive, single-centre cohort study included patients with suspected CSPH. Baseline assessment comprised transient elastography of the liver and spleen (FibroScan) and laboratory testing for FIB-4 score calculation. Endoscopic evaluation consisted of upper gastrointestinal endoscopy to assess signs of portal hypertension, followed by EUS using a linear echoendoscope (FujiFilm 740UT) connected to an Arietta-850 ultrasound system, under deep sedation. EUS-SWE was performed and liver stiffness recorded in kilopascals (kPa). EUS-PPG was measured using a standard 22G needle, with the gradient defined as the difference between mean portal venous and hepatic venous pressures. LF was determined histologically after EUS-guided liver biopsy with a 19G needle. The primary outcome was the correlation among EUS-PPG, EUS-SWE, and histological LF. Secondary outcomes included technical success, correlations with other clinical parameters, and adverse events. Correlation analyses were performed using Spearman’s test and biserial correlation. Data are reported as mean values and percentages. Results Nineteen patients were included (mean age 58.9±11.5 years; 17 males, 85%). Technical success was achieved in 18/19 cases (94.7%), and no adverse events occurred. Mean PPG was 5.9±4.5 mmHg (range 0–17), mean EUS-SWE was 18.6±9.9 kPa (8.1–40.3), and mean liver FibroScan was 12.4±11.2 kPa (4.1–54.7). Oesophageal varices were detected in 2 patients (10.5%) and gastric varices in 1 patient (5.3%). Histological fibrosis (METAVIR) was as follows: F0 (n=5, 29.4%), F1 (n=1, 5.9%), F2 (n=1, 5.9%), F3 (n=6, 35.3%), and F4 (n=4, 23.5%). Correlation between EUS-PPG and LF, liver FibroScan, and EUS-SWE was 0.548 (p=0.028), 0.679 (p=0.003), and 0.288 (p=0.247), respectively. Correlation between EUS-SWE and liver FibroScan and LF was 0.579 (p=0.012) and 0.699 (p=0.002), respectively. Conclusions EUS-PPG is a safe and feasible technique that correlates well with liver FibroScan and histological fibrosis. EUS-SWE appears to be a promising surrogate marker of liver fibrosis in patients with suspected portal hypertension. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany