EUS ‐ PPG Measured Distal to the Thrombus: A Reliable Way to Detect the Pressure Gradient in Patients With Cirrhosis and Portal Vein Thrombosis

OBJECTIVES: In patients with portal vein thrombosis (PVT), hepatic venous pressure gradient (HVPG) does not accurately reflect portal pressure. This study aimed to evaluate the application of endoscopic ultrasound (EUS)-guided portal pressure gradient (PPG) in cirrhotic patients with PVT. METHODS: In patients with cirrhosis who had gastroesophageal varices (GEV) and PVT were included. The PPG proximal to the PVT (Pro-PVT PPG), PPG distal to the PVT (Dis-PVT PPG), and gastric variceal pressure gradient (GVPG) were measured by puncturing the target vessels under the guidance of EUS. The pressure gradients measured using different methods were compared and correlated with clinical characteristics. RESULTS: A total of 51 patients with GEV and PVT were included in the final analysis. There was a substantial agreement between Dis-PVT PPG and GVPG, with an intraclass correlation coefficient (ICC) of 0.693 (0.514-0.813). Dis-PVT PPG and GVPG were significantly higher in the patients with bleeding history than in those without (17.0 mmHg vs. 11.3 mmHg, and 18.0 mmHg vs. 7.0 mmHg, p < 0.01 for both). In addition, patients with a Dis-PVT PPG ≥ 12 mmHg had a higher incidence of red sign (odds ratio [OR] = 5.6, 95% confidence interval [CI] = 1.6-20.2) and bleeding history (OR = 7.0, 95% CI = 2.0-26.4). CONCLUSIONS: Dis-PVT PPG may be a preferred index that reflects the status of portal hypertension in cirrhotic patients with PVT and is associated with a bleeding history of GEV.