The development of Clinical significant PH (CSPH) is a major driver of complications. PPG is the strongest predictor of decompensation . The shortcomings of GPVH measurements and invasiveness has resulted in an area of unmet clinical need. Non-selective beta-blockers (NSBB) have demonstrated efficacy in reducing PH. However, this requires a second invasive procedure, and there is high interindividual variability in the hemodynamic response to NSBB. EUS-guided GPP measurement emerges as a more accurate, accessible and less invasive technique to potentially predict chronic hemodynamic response. The aim of this project is to assess the safety and efficacy of EUS-derived GPP measurement (EUS-GPP) in patients diagnosed with cirrhosis, to assess the acute hemodynamic response through EUS-derived GPP to intravenous propranolol administration in order to determine the patients who would benefit from NSBB treatment in primary prophylaxis to prevent decompensation using a strategy guided by EUS-GPP measurement.
Patients diagnosed with advanced liver disease with an indication for primary prophylaxis with NSBBs
None
All patients attending the hepatology clinic or hospitalized with a diagnosis of liver cirrhosis and an indication for primary prophylaxis with NSBBs will be prospectively and consecutively included
Cohort
Prospective
Not listed
- Endoscopic ultrasound with determination of the portal venous pressure gradient using a 25G needle with adapted
The portal pressure gradient (PPG) is obtained via transgastric, ultrasound-guided intraparenchymal hepatic puncture using a 25G needle (EchoTip Insight, Cook Medical®) equipped with a pressure gauge. Measurements are obtained in mm Hg. A puncture is made in the middle hepatic vein, and three pressure determinations are taken, each lasting one minute. The lowest observed pressure is recorded, and the mean is calculated. Subsequently, the left branch of the portal vein is punctured, and three measurements are taken, each lasting one minute, and their mean is calculated. The PPG is obtained by subtracting the mean pressures in the portal vein from the mean pressures in the hepatic vein. The pressure gauge recording the pressures is always fixed in the same position for all pressure measurements, positioned at the level of the patient's venous axis. After the initial hemodynamic assessment, propranolol (0.15 mg/kg of body weight; aqueous solution of propranolol hydrochloride \[1 mg/ml\] st
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