Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER) : A bicentric EU study
Vanderschueren, Emma (Catholic University of Leuven)
Laleman, Wim (University of Münster)
Bonne, Lawrence (University Hospital Leuven)
Maleux, Geert (University Hospital Leuven)
Wagner, David R. (MED-Surg Division. Cook Medical)
Yeh, Chyon (Cook Research Incorporated)
Calvo, Andrea (Hospital Clínic i Provincial de Barcelona)
Sendino, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Gines, Angels (Hospital Clínic i Provincial de Barcelona)
Baiges, Anna (Hospital Clínic i Provincial de Barcelona)
Bruno, Marco J. (Erasmus MC University Medical Center)
García-Pagán, JC (Hospital Clínic i Provincial de Barcelona)
van der Merwe, Schalk (Catholic University of Leuven)
Universitat Autònoma de Barcelona

Data:	2025
Resum:	Background & Aims: Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availability pose challenges. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) provides a direct alternative. The ENCOUNTER study is the first to compare EUS-PPG to HVPG in the same patient, simultaneously. Methods: This prospective, international, bicentric study included patients referred for HVPG or transjugular intrahepatic portosystemic shunt (TIPS) placement at the University Hospital of Leuven (Belgium) and Hospital Clinic Barcelona (Spain). Patients underwent standard-of-care HVPG, followed by simultaneous HVPG and EUS-PPG measurements under propofol general anesthesia. Results: The final analysis included 21 patients with cirrhosis undergoing simultaneous HVPG and EUS-PPG measurements, of whom 15 received TIPS. Mean HVPG and EUS-PPG values under general anesthesia were comparable (11. 9 ± 5. 2 vs. 10. 9 ± 5. 6 mmHg, p = 0. 2332) and showed good correlation (r = 0. 74, p = 0. 0001). The individual pressure components also showed a good correlation (portal vein: r = 0. 85, p <0. 0001; hepatic vein: r = 0. 72, p = 0. 0003). In patients receiving TIPS, direct transjugular portal pressure measurements demonstrated an excellent correlation with EUS-guided portal pressures (r = 0. 91, p <0. 0001). Technical success was achieved in all cases, with no adverse events associated with the EUS-PPG procedure. Conclusion: EUS-PPG is a reliable and safe alternative to HVPG for the direct measurement of portal pressure. However, attention must be paid to technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia, which may alter pressure measurements and subsequently affect risk classification. Impact and implications: The ENCOUNTER study is the first study to directly compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with hepatic venous pressure gradient (HVPG) in the same patients, simultaneously. EUS-PPG is a safe and reliable direct alternative to HVPG for measuring portal pressure. However, technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia must be considered. EUS-PPG is particularly attractive for patients with chronic liver disease who have conflicting non-invasive test results, require additional endoscopic procedures, or in cases where HVPG may underestimate true portal pressure. ClinicalTrials. gov: NCT04987034.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	HVPG ; Endoscopy ; Endosonography ; Portal hypertension ; Portal pressure
Publicat a:	JHEP Reports, Vol. 7 Núm. 8 (august 2025) , p. 101466, ISSN 2589-5559

DOI: 10.1016/j.jhepr.2025.101466
PMID: 40689144

11 p, 1.2 MB

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