P2337 - Incongruent EUS-PPG vs Trans Jugular HVPG: A Case Series

Award: Presidential Poster Award

Kelli Kosako Yost, MD, Wahid Wassef, MD, MPH, FACG, Moises I. Nevah Rubin, MD, Ma Ai Thanda Han, MD
University of Arizona College of Medicine, Phoenix, AZ

Introduction: The gold standard of measuring portal hypertension is through a trans jugular approach, measuring the hepatic venous pressure gradient (HVPG). This is an invasive procedure and only measures an indirect estimate, the wedge hepatic venous pressure (WHVP). In contrast, the FDA approved EUS-guided portal pressure gradient (PPG) measurement can measure direct portal pressure and variceal screening can be done concomitantly. We present two patients who underwent both procedures and compare the clinical correlations.

Case Description/Methods: A 61 y.o female with ESRD on dialysis was found to have cirrhotic liver morphology on CT scan. The patient had normal LFTs, albumin, bilirubin, INR, and platelets. Trans jugular approach showed right atrial pressure of 7 mmHg, free hepatic vein pressure of 11 mmHg, WHVP of 24 mmHg, and HVPG of 13. Trans-jugular liver biopsy (1.5 cm tissue length) revealed steatohepatitis and bridging fibrosis. EUS-guided PPG revealed mean left hepatic vein pressure of 15mmHg, mean left portal vein pressure of 20mmHg, and PPG of 5. EGD showed no evidence of varices/portal hypertensive changes. EUS liver biopsy (2.5 cm tissue length) revealed steatohepatitis and patchy portal and sinusoidal fibrosis.

A 29 y.o female with type 2 diabetes and obesity was found to have elevated LFTs (AST 132 U/L, ALT 497U/L) and nodular contour of liver on CT. Trans jugular approach showed right atrial pressure of 10 mmHg, free hepatic vein pressure of 16 mmHg, WHVP of 30 mmHg, and HVPG of 14. Trans-jugular liver biopsy (2.1 cm tissue length) revealed portal and lobular hepatitis with no definitive fibrosis. EUS-guided PPG revealed mean left hepatic vein pressure of 14 mmHg, mean left portal vein pressure of 16 mmHg, and PPG of 2. EGD showed no evidence of varices/portal hypertensive changes. EUS liver biopsy (2.5 cm tissue length) revealed active portal hepatitis with scattered necrotic hepatocytes without fibrosis.

Discussion: EUS-PPG has excellent correlation with HVPG measurements and consistent results in animal studies. In this study, although HVPG was elevated suggesting portal hypertension, EUS-PPG values were within the normal range, correlating with clinical, endoscopic, histologic, and laboratory findings. There were no procedural complications and lengths of the EUS biopsies taken were longer than trans jugular biopsies, further proving the technical validity. FDA approved EUS-PPG shows a promising and convenient alternative to portal pressure measurements in the future.


Disclosures:


Kelli Kosako Yost, MD, Wahid Wassef, MD, MPH, FACG, Moises I. Nevah Rubin, MD, Ma Ai Thanda Han, MD. P2337 - Incongruent EUS-PPG vs Trans Jugular HVPG: A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.