Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study
Background & Aims: Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availabili...
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Elsevier
2025-08-01
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| author | Emma Vanderschueren Wim Laleman Lawrence Bonne Geert Maleux David R. Wagner Chyon Yeh Andrea Calvo Oriol Sendino Angels Gines Anna Baiges Marco J. Bruno Juan Carlos Garcia-Pagan Schalk van der Merwe |
| author_facet | Emma Vanderschueren Wim Laleman Lawrence Bonne Geert Maleux David R. Wagner Chyon Yeh Andrea Calvo Oriol Sendino Angels Gines Anna Baiges Marco J. Bruno Juan Carlos Garcia-Pagan Schalk van der Merwe |
| author_sort | Emma Vanderschueren |
| collection | DOAJ |
| description | Background & Aims: Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availability pose challenges. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) provides a direct alternative. The ENCOUNTER study is the first to compare EUS-PPG to HVPG in the same patient, simultaneously. Methods: This prospective, international, bicentric study included patients referred for HVPG or transjugular intrahepatic portosystemic shunt (TIPS) placement at the University Hospital of Leuven (Belgium) and Hospital Clinic Barcelona (Spain). Patients underwent standard-of-care HVPG, followed by simultaneous HVPG and EUS-PPG measurements under propofol general anesthesia. Results: The final analysis included 21 patients with cirrhosis undergoing simultaneous HVPG and EUS-PPG measurements, of whom 15 received TIPS. Mean HVPG and EUS-PPG values under general anesthesia were comparable (11.9 ± 5.2 vs. 10.9 ± 5.6 mmHg, p = 0.2332) and showed good correlation (r = 0.74, p = 0.0001). The individual pressure components also showed a good correlation (portal vein: r = 0.85, p <0.0001; hepatic vein: r = 0.72, p = 0.0003). In patients receiving TIPS, direct transjugular portal pressure measurements demonstrated an excellent correlation with EUS-guided portal pressures (r = 0.91, p <0.0001). Technical success was achieved in all cases, with no adverse events associated with the EUS-PPG procedure. Conclusion: EUS-PPG is a reliable and safe alternative to HVPG for the direct measurement of portal pressure. However, attention must be paid to technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia, which may alter pressure measurements and subsequently affect risk classification. Impact and implications: The ENCOUNTER study is the first study to directly compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with hepatic venous pressure gradient (HVPG) in the same patients, simultaneously. EUS-PPG is a safe and reliable direct alternative to HVPG for measuring portal pressure. However, technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia must be considered. EUS-PPG is particularly attractive for patients with chronic liver disease who have conflicting non-invasive test results, require additional endoscopic procedures, or in cases where HVPG may underestimate true portal pressure. ClinicalTrials.gov: NCT04987034. |
| format | Article |
| id | doaj-art-aea38e5b59304c06b5479d4dfdfa8aa7 |
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| publishDate | 2025-08-01 |
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| spelling | doaj-art-aea38e5b59304c06b5479d4dfdfa8aa72025-07-12T04:46:34ZengElsevierJHEP Reports2589-55592025-08-0178101466Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU studyEmma Vanderschueren0Wim Laleman1Lawrence Bonne2Geert Maleux3David R. Wagner4Chyon Yeh5Andrea Calvo6Oriol Sendino7Angels Gines8Anna Baiges9Marco J. Bruno10Juan Carlos Garcia-Pagan11Schalk van der Merwe12Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Aging (CHROMETA), Catholic University of Leuven, Leuven, Belgium; Corresponding authors. Address: University Hospital Leuven campus Gasthuisberg, Department of Gastroenterology and Hepatology, Herestraat 49, 3000 Leuven, Belgium; Tel.: +32 16 34 42 99, fax: +32 16 34 43 87.Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Internal Medicine B, University of Münster, Münster, GermanyDepartment of Radiology, Interventional Radiology, University Hospital Leuven, Leuven, BelgiumDepartment of Radiology, Interventional Radiology, University Hospital Leuven, Leuven, BelgiumMED-Surg Division, Cook Medical, Bloomington, Indiana, USACook Research Incorporated, West Lafayette, Indiana, USADepartment of Anesthesiology, Critical Care and Pain Medicine, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, SpainEndoscopy Unit, Department of Digestive Diseases, Parc Tauli University Hospital, Investigation and Innovation Institute Parc Tauli I3PT, Universitat Autonoma of Barcelona, Sabadell, SpainEndoscopy Unit, Service of Gastroenterology, Institut Clinic de Malalties Digestives i Metaboliques, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, SpainBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Department de Medicina I Ciènces de la Salut. Universitat de Barcelona, Barcelona. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Rare Liver), SpainDepartment of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the NetherlandsBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Department de Medicina I Ciènces de la Salut. Universitat de Barcelona, Barcelona. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Rare Liver), SpainDepartment of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Aging (CHROMETA), Catholic University of Leuven, Leuven, Belgium; Corresponding authors. Address: University Hospital Leuven campus Gasthuisberg, Department of Gastroenterology and Hepatology, Herestraat 49, 3000 Leuven, Belgium; Tel.: +32 16 34 42 99, fax: +32 16 34 43 87.Background & Aims: Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availability pose challenges. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) provides a direct alternative. The ENCOUNTER study is the first to compare EUS-PPG to HVPG in the same patient, simultaneously. Methods: This prospective, international, bicentric study included patients referred for HVPG or transjugular intrahepatic portosystemic shunt (TIPS) placement at the University Hospital of Leuven (Belgium) and Hospital Clinic Barcelona (Spain). Patients underwent standard-of-care HVPG, followed by simultaneous HVPG and EUS-PPG measurements under propofol general anesthesia. Results: The final analysis included 21 patients with cirrhosis undergoing simultaneous HVPG and EUS-PPG measurements, of whom 15 received TIPS. Mean HVPG and EUS-PPG values under general anesthesia were comparable (11.9 ± 5.2 vs. 10.9 ± 5.6 mmHg, p = 0.2332) and showed good correlation (r = 0.74, p = 0.0001). The individual pressure components also showed a good correlation (portal vein: r = 0.85, p <0.0001; hepatic vein: r = 0.72, p = 0.0003). In patients receiving TIPS, direct transjugular portal pressure measurements demonstrated an excellent correlation with EUS-guided portal pressures (r = 0.91, p <0.0001). Technical success was achieved in all cases, with no adverse events associated with the EUS-PPG procedure. Conclusion: EUS-PPG is a reliable and safe alternative to HVPG for the direct measurement of portal pressure. However, attention must be paid to technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia, which may alter pressure measurements and subsequently affect risk classification. Impact and implications: The ENCOUNTER study is the first study to directly compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with hepatic venous pressure gradient (HVPG) in the same patients, simultaneously. EUS-PPG is a safe and reliable direct alternative to HVPG for measuring portal pressure. However, technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia must be considered. EUS-PPG is particularly attractive for patients with chronic liver disease who have conflicting non-invasive test results, require additional endoscopic procedures, or in cases where HVPG may underestimate true portal pressure. ClinicalTrials.gov: NCT04987034.http://www.sciencedirect.com/science/article/pii/S2589555925001442portal hypertensionportal pressureendosonographyendoscopyHVPG |
| spellingShingle | Emma Vanderschueren Wim Laleman Lawrence Bonne Geert Maleux David R. Wagner Chyon Yeh Andrea Calvo Oriol Sendino Angels Gines Anna Baiges Marco J. Bruno Juan Carlos Garcia-Pagan Schalk van der Merwe Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study JHEP Reports portal hypertension portal pressure endosonography endoscopy HVPG |
| title | Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study |
| title_full | Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study |
| title_fullStr | Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study |
| title_full_unstemmed | Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study |
| title_short | Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER): A bicentric EU study |
| title_sort | endoscopic ultrasound guided portosystemic pressure gradient measurement vs transjugular balloon occlusion measurement in patients with cirrhosis encounter a bicentric eu study |
| topic | portal hypertension portal pressure endosonography endoscopy HVPG |
| url | http://www.sciencedirect.com/science/article/pii/S2589555925001442 |
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