Endoscopic ultrasound‐guided portal pressure gradient identifies patients with previously undiagnosed clinically significant portal hypertension

Aims Portal hypertension (PH) is a complication of cirrhosis that leads to hepatic decompensation. Assessing the portal pressure gradient (PPG) provides valuable information for disease assessment, staging, and prognosis. In this study, we aimed to report the utilization of endoscopic ultrasound (EUS)‐guided PPG (EUS‐PPG) measurements in a real‐world setting. Methods This retrospective analysis included patients at a tertiary care center who underwent EUS‐PPG between February 2021 and May 2022. The most common indication was to establish or exclude the diagnosis of cirrhosis, followed by an assessment of surgical risk in the setting of suspected cirrhosis. Extensive demographic and clinical data were collected, and statistical analysis was performed using the Student's t test. Results Eighteen patients underwent EUS‐PPG. Technical success was achieved in 17 of the 18 patients. No complications were observed. The mean scores of Child‐Pugh, Model for End‐Stage Liver Disease‐Sodium, and Fibrosis‐4 scores were 5.1 ± 0.5, 9.0 ± 3.0, and 3.7 ± 4.5, respectively. Of the 18 patients, two presented with esophageal varices and six with portal hypertensive gastropathy. The mean PPG was 5.8 ± 4.5 mmHg, and five patients exhibited clinically significant PH (CSPH). Of the 18 patients, 15 underwent concurrent EUS‐liver biopsy, which was 100% successful and provided diagnostic histology for all patients. The PPG data led to changes in the clinical management of 17 patients. Conclusions EUS‐PPG is safe and technically feasible. The Child‐Pugh score did not correlate well with the presence of CSPH; however, PPG measurements resulted in changes in the management of almost all patients. Larger studies correlating EUS‐PPG with other assessments of liver diseases are required. Endoscopic ultrasound (EUS)‐guided portal pressure gradient (PPG) is safe and technically feasible. The Child‐Pugh score did not correlate well with the presence of clinically significant portal hypertension; however, PPG measurements resulted in changes in the management of almost all patients. Larger studies correlating EUS‐PPG with other assessments of liver diseases are required. Highlights Significant findings of the study: This study indicates that endoscopic ultrasound (EUS)‐guided portal pressure gradient (EUS‐PPG) is safe and technically feasible in the clinical setting. What this study adds: The use of EUS‐PPG led to changes in the management of almost all patients.