E0430 - EUS Assessment of Portal Pressure Gradient Identifies a Significant Amount of Previously Undiagnosed Clinically Significant Portal Hypertension

Jerome C. Edelson, MD¹, Scott Edelson, MD², Don Rockey, MD³, Christian Horn, MD⁴, John Magulick, MD⁵, John Quiles, MD^4
1Brooke Army Medical Center, San Antonio, TX; ²Brooke Army Medical Center, Fort Sam Houston, TX; ³Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC; ⁴San Antonio Military Medical Center, Fort Sam Houston, TX; ⁵San Antonio Uniformed Services Health Education Consortium, San Antonio, TX

Introduction: Portal hypertension (PH) is a complication of cirrhosis and a harbinger of decompensation. Assessment of the portal pressure gradient (PPG) provides valuable information to aid in the assessment, staging, and prognostication of disease. Previously, PPG assessment was performed by interventional radiology and did not include simultaneous endoscopic assessment. Newer techniques have been developed that enable direct EUS directed vascular access, enabling assessment by endoscopists. We report our data on a real-world experience in the utilization of this technique.

Methods: We performed a retrospective analysis of patients who underwent EUS-PPG from February 2021 to May 2022 performed at a military tertiary care center. Extensive demographic and clinical data were abstracted (including indication, referral source, effect on management, medical history, social history, endoscopic findings, procedural characteristics, and biopsy results). Statistical analysis was performed with t-test assays.

Results: 18 patients underwent EUS-PPG (Table 1). Technical success was achieved in 17/18 patients. There were no adverse events. Average age was 64 years, 72% were male, 33% had a prior history of NAFLD/NASH, and 22% had a known diagnosis of cirrhosis. The average Child-Pugh score was 5.1 ± 0.5, MELD-Na was 9 ± 3, and FIB-4 was 3.74 ± 4.5. The most common indication for evaluation was to establish or exclude the diagnosis of cirrhosis. Esophageal varices were present in 11% of patients and portal hypertensive gastropathy was present in 33%. On EUS, 33% of patients had a nodular liver contour. The mean PPG was 5.8 ± 4.5 mmHg and 27% of patients had clinically significant portal hypertension (CSPH, PPG ≥ 10 mm Hg). The middle hepatic vein and left portal vein were the most frequently accessed. Concurrent EUS-liver biopsy was performed in 15/18 patients, was 100% diagnostic, and concordant with PPG findings. The left lobe was most commonly accessed (73%) and bilobar biopsy was performed in 26%. PPG data led to management changes in 94% of patients including confirming or refuting a diagnosis of cirrhosis, changing medications, or proceeding with surgery.

Discussion: EUS-PPG is safe and technically feasible. PPG measurement resulted in significant changes in patient management. Larger studies are required to correlate EUS-PPG with other non-invasive assessments of liver disease.



Disclosures:


Jerome C. Edelson, MD¹, Scott Edelson, MD², Don Rockey, MD³, Christian Horn, MD⁴, John Magulick, MD⁵, John Quiles, MD⁴. E0430 - EUS Assessment of Portal Pressure Gradient Identifies a Significant Amount of Previously Undiagnosed Clinically Significant Portal Hypertension, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.