S2205 Impact of EUS-Guided Portal Pressure Gradient Measurements on Clinical Practice: A Prospective Case Series

Introduction: Endoscopic ultrasound (EUS)-guided portal pressure gradient (EUS-PPG) measurements offer an alternative approach to the traditional method of obtaining this crucial prognostic information for liver diseases, typically performed by interventional radiologists. In this cohort of patients, we evaluated not only the safety and efficacy of the procedure but also its impact in clinical practice based on the obtained results. Methods: All patients who had EUS-PPG in a tertiary care center were included in the study. Patients’ demographics, type of referral physicians, procedure related side effects, and clinical implications of the result were recorded. Results: Eleven patients (8 men, age range: 21-75 years) successfully underwent upper endoscopy with EUS-PPG. Referrals came from surgical oncologists (4), hepatologists (5), and interventional gastroenterologists (2). One patient had 2 failed interventional radiology procedure due to jugular vein thrombosis. Six patients were referred for pre-surgical evaluation due to a history of liver disease, while the remaining patients were referred for a more definitive diagnosis of liver or advanced liver disease. Esophageal varices and portal hypertension were observed in 2 patients, without the presence of gastric antral vascular ectasia (GAVE). EUS-PPG was successfully completed in all patients, with a median hepatico-portal venous gradient of 3 (range: 0-10). One patient experienced post-procedural pain requiring a one-day hospital stay; however, no other adverse events were reported. Of the 4 patients referred by surgical oncologists, 3 underwent their planned surgeries (partial gastrectomy, partial hepatectomy, and Whipple procedure) with favorable outcomes from a liver perspective. The fourth patient, who had a high portal pressure gradient, alternate path of gastric tumor resection, Endoscopic Submucosal Dissection (ESD), which was completed without complication. Conclusion: EUS-PPG measurement provides an alternative approach to assessing portal hypertension. This technique enhances accessibility of portal pressure assessment to a broader range of subspecialties. Its demonstrated safety and efficacy, combined with the ability to obtain both endoscopic and ultrasound data in a single session, offer valuable clinical insights. These insights assist physicians in determining a patient’s suitability for major surgical interventions or the need for continued surveillance and further evaluation.