Endohepatlogy: Endoscopic Ultrasound-Guided Portal Pressure Gradient and Liver Biopsy in a Patient with Presinusoidal Portal Hypertension

Abstract: Liver disease progressing to cirrhosis is one of the leading causes of mortality in the U.S. Portal hypertension (PH) most commonly results from cirrhosis of the liver. The gold-standard for diagnosis of PH in the U.S. is measured by interventional radiology using hepatic venous pressure gradients (HVPG). Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) is an advanced, novel procedure that directly measures the portal and hepatic vein pressure and has comparable mean pressure measurements to HVPG with fewer adverse events. Additionally, it allows for concomitant endoscopic evaluation, endoscopic ultrasound imaging, liver biopsy, and other endoscopic interventions. In this article, we report a case of a 50-year-old female patient with metabolic dysfunction-associated steatohepatitis (MASH) and primary biliary cholangitis (PBC) who underwent EUS-PPG and EUS-guided liver biopsy for further work up. Keywords: endoscopy, endoscopic ultrasound, endoscopic ultrasound-guided portal pressure gradient, portal hypertension, portal pressure, hepatic cirrhosis.