Left Lateral Position and Supine Position in EUS-PPG Measurement

The hepatic venous pressure gradient (HVPG) remains the gold standard for assessing portal hypertension, yet its clinical application faces several limitations. First, HVPG has restricted diagnostic scope, being unable to accurately evaluate prehepatic or presinusoidal portal hypertension. Second, the measurement process exposes both patients and physicians to radiation and involves complex techniques that preclude routine implementation in many hospitals. Finally, as HVPG indirectly estimates portal pressure through wedged hepatic venous pressure, its accuracy may be compromised by multiple factors including intrahepatic venous shunting, catheter insertion depth, excessive sedation or patient agitation during the procedure, and incomplete balloon occlusion of hepatic venous flow.

Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement effectively addresses these limitations of HVPG. Current clinical studies on EUS-PPG have predominantly been conducted in the supine position. However, this position significantly increases the technical difficulty of endoscopic ultrasonography and complicates the simultaneous performance of endoscopic selective varices devascularization (EUS-ESVD) under single anesthesia. The consistency of EUS-PPG measurements between left lateral decubitus and supine positions requires further investigation.

This prospective comparative study enrolls hospitalized patients with liver cirrhosis. EUS-guided puncture of both the portal vein and hepatic vein were performed using a 25G needle. Pressure transducers measure the portal venous pressure (PVP) and hepatic venous pressure (HVP), with their differential defined as EUS-PPG. Measurements obtained in supine position are designated EUS-suPPG, while those in left lateral decubitus position are termed EUS-lePPG. Statistical analysis will evaluate the correlation between EUS-suPPG and EUS-lePPG values, with postoperative monitoring for complications including infection and hemorrhage.

Inclusion criteria

Hospitalized patients with liver cirrhosis, and are willing to sign the informed consent.

Exclusion criteria

• Unwilling to sign the informed consent
• Severe coagulopathy (INR>1.6)
• Severe thrombocytopenia (platelets <20,000/μL)
• Bacteremia
• Age<18, or≥81
• Pregnancy