EUS-PPG vs HVPG in Portal Hypertension

Hospital General Universitario de Alicante33 enrolled

Overview

The objective of this study is to evaluate the correlation of the calculated portal pressure gradient (PPG) obtained by direct portal and hepatic pressure measurements with a conventional 22 G needle guided by EUS and indirect portal vein pressure measurements using the interventional radiology based hepatic venous pressure gradient (HVPG) procedure.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Cirrhosis Portal Hypertension

Interventions

EUS-PPG and HVPGDIAGNOSTIC_TEST

EUS-PPG and HVPG will be measured in all patients. Under deep sedation with propofol, an echoendoscopy will be performed. After identifying the left or middle suprahepatic vein, it will be punctured with a standard 22 G needle. The needle will be previously purged with heparinized saline and connected to a venous pressure monitor via an arterial pressure system, which will be calibrated to zero at the level of the axillary midline, at the level of the atrium. Subsequently, the left portal vein will be identified from the stomach or duodenum, repeating the procedure. From each vessel 3 measurements will be taken by flushing 1-2 ml of heparinized saline. The mean of the three measurements will be obtained. On the same day or on successive days HVPG measurement will be performed.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age above 18 years * Undergoing evaluation for chronic liver disease or portal hypertension * Signed informed consent Exclusion Criteria: * Uncorrectable coagulopathy (INR above 1.5) * Uncorrectable thrombocytopenia (Platelets under 50,000) * Anticoagulation or antiplatelet therapy that cannot be discontinued * Biliary obstruction * Grade II ascites or more * Intrahepatic portal vein thrombosis * Pregnancy

Locations (1)

Unidad de Endoscopia. Hospital General Universitario de Alicante

Alicante, Spain

Outcomes

Primary Outcomes

Intra-class correlation coefficient between portal pressure gradient measurement by EUS and hepatic venous pressure gradient measurement measured by interventional radiology.

Portal pressure gradient measurement will be performed by direct echoendoscopy-guided puncture with a 22 G needle of the portal vein and the suprahepatic vein. On the same day or on successive days, hepatic venous pressure gradient determination will be performed by interventional radiology. For this purpose, the free hepatic venous pressure and the wedged pressure will be measured using a balloon catheter and jugular approach, following the usual procedure.

Time frame: 1 day

Secondary Outcomes

Technical success of both procedures measured as the number of procedures successfully performed divided by the total number of patients.

The percentage of echoendoscopy-guided portal pressure gradient (EUS-PPG) measurements versus the percentage of successful hepatic venous pressure gradient (HVPG) measurements using Chi-square will be compared.

Time frame: 1 day

Adverse effects at 30 days after each procedure by clinical follow-up of patients at 24 hours, 7 days, and 30 days using the American Society of Gastrointestinal Endoscopy Severity grading system, from mild to fatal.

Proportion of adverse events in the EUS-PPG and HVPG using Chi-square.

Time frame: 30 days

Data from ClinicalTrials.gov

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