The goal of this interventional trial is to compare in measuring of portal hypertension by HVPG and EUS-PPG in subject indicated to HVPG measurement.
The primary question is whether EUS-PPG provides measurements really equivalent to HVPG in terms of gradient accuracy.
Participants undergoing HVPG will first undergo the procedure while conscious, performed by the first operator. Immediately thereafter, HVPG will be repeated following the induction of anesthesia by a second operator blinded to the initial readings. Subsequently, EUS-PPG will be performed by an endoscopist, who will also be blinded to all previous pressure measurements.
Age 18-75 years at the time of enrollment; signed informed consent
Clinical indication for HVPG measurement and/or transjugular liver biopsy for chronic advanced liver disease
Severe co-morbidities (e.g., advanced chronic heart failure, chronic renal insufficiency stage 4 and above, long-term poorly compensated diabetes mellitus with severe complications)
Pregnancy
Estimated patient non-compliance and/or not signing of the informed consent
Documented iodine contrast dye allergy
Single group
Hepatic venous pressure gradient measurement
Procedure/SurgeryHVPG measurement is minimally invasive procedure that involves cannulation of the right internal jugular vein, followed by the insertion of a balloon-occlusion catheter into the right or middle hepatic vein to measure both free hepatic vein pressure and wedged hepatic vein pressure, enabling the calculation of HVPG. Additionally, this method allows for liver biopsy during the same session. HVPG is widely regarded as the gold standard for PPG measurement.
Endoscopic ultrasound-guided portal pressure gradient measurement
Procedure/SurgeryRecent advancements in the field of digestive endoscopy have introduced an innovative alternative: endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement. This emerging technique shows promise for further improving the accessibility of portal hypertension assessment and also offers the possibility of liver biopsy in one session. EUS-PPG may have several advantages, including its minimally invasive nature, safety profile, high technical success rate, the possibility of a "one-stopshop" approach (combining EUS-PPG, liver biopsy, and endoscopic treatment of esophageal varices), absence of radiation exposure.
Evaluation of the consistency between the HVPG and EUS-PPG
The primary objective of this project is to determine whether EUS-PPG is fully comparable to HVPG in terms of accuracy. This will be assessed through a direct, one-session comparison of measurements obtained by both methods.
Evaluation of influence of sedation on measurements
The secondary objective is to evaluate the precise influence of sedation on EUS-PPG results compared to HVPG performed in both conscious and sedated states.
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Military University Hospital, Prague
Lead sponsor
University Hospital Prague (IKEM), Prague, Czech Republic
Collaborator
