E0482 - EUS-Guided Portal Pressure Measurement Predictive of Clinically Significant Portal Hypertension: A Carilion Clinic Experience

Diana Dougherty, MD¹, William Abel, MD¹, Shravani Reddy, MD¹, Adil Mir, MD¹, Paul Yeaton, MD¹, Vivek Kesar, MD^2
1Virginia Tech Carilion School of Medicine, Roanoke, VA; ²Virginia Tech Carilion, Roanoke, VA

Introduction: Endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPGM) is a novel technique that quantifies portal hypertension. Clinically significant portal hypertension is currently defined by hepatic venous pressure gradient (HVPG) > 10mmHg. We aimed to assess the safety, technical success of PPGM and correlation with clinical markers of advanced liver disease.

Methods: This is a single-center retrospective study of patients with suspected chronic liver disease who have undergone EUS-PPG with or without EUS-guided liver biopsy (EUS-Bx). Cases with EUS-PPG were identified at Carilion Roanoke Memorial Hospital a tertiary care hospital in Roanoke, Virginia, between September 2020 and March 2022. The electronic medical record (EMR) was reviewed for patient demographics, non-invasive markers, and clinical indicators of liver disease severity. Data collection and analysis is ongoing.

Results: Of the 73 patients included, 57% were female, with mean age 58, and mean BMI 34.9. The most common indication for the procedure was history of NAFLD/NASH (33/73) and most patients (69/73) did not have previously established cirrhosis. 71/73 (97.3%) of procedures were technically successful, with instances of failure related to inability to cannulate the hepatic or portal vein. No major adverse events were identified. The mean PPG was 5.5 mmHg (SD 4.6, range 0-17.3). Increasing Fib-4 and APRI scores were positively correlated with higher PPG. In patients with Fib-4< 1.3 the mean PPG was 3.2, vs 8.8 in those with Fib-4 >2.67. EUS-Bx was performed in 46 patients (63%) and NASH histologically diagnosed in (33/46) with cirrhosis confirmed in 12 (26%). Compared to an overall average fibrosis score of 2.3,the average score was 1.5 in patients with PPG < 5 and 4.0 in patients with PPG >10. Average PPG was higher in patients diagnosed with cirrhosis (7.38 vs 3.45).

Discussion: Our findings are consistent with recent reports, suggesting that EUS-PPGM is a safe and effective method with good correlation to clinical indicators of advanced liver disease. It has the added advantage of allowing EUS-bx and endoscopic assessment of clinical features of portal hypertension during the same procedure. Future research should assess how EUS-PPG measurements can be utilized in routine clinical practice.


Disclosures:


Diana Dougherty, MD¹, William Abel, MD¹, Shravani Reddy, MD¹, Adil Mir, MD¹, Paul Yeaton, MD¹, Vivek Kesar, MD². E0482 - EUS-Guided Portal Pressure Measurement Predictive of Clinically Significant Portal Hypertension: A Carilion Clinic Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.