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.
Key Findings
Results
EUS-guided portal pressure gradient measured distal to the thrombus (Dis-PVT PPG) showed substantial agreement with gastric variceal pressure gradient (GVPG) in cirrhotic patients with gastroesophageal varices and portal vein thrombosis.
51 patients with gastroesophageal varices (GEV) and PVT were included in the final analysis.
The intraclass correlation coefficient (ICC) between Dis-PVT PPG and GVPG was 0.693 (0.514-0.813).
Pressure gradients were measured by EUS-guided puncture of target vessels: proximal to the PVT (Pro-PVT PPG), distal to the PVT (Dis-PVT PPG), and gastric varices (GVPG).
Results
Dis-PVT PPG and GVPG were significantly higher in patients with a history of GEV bleeding than in those without.
Dis-PVT PPG was 17.0 mmHg in patients with bleeding history vs. 11.3 mmHg in those without (p < 0.01).
GVPG was 18.0 mmHg in patients with bleeding history vs. 7.0 mmHg in those without (p < 0.01).
Results
A Dis-PVT PPG of 12 mmHg or higher was associated with higher odds of red sign and of bleeding history.
Red sign: odds ratio 5.6 (95% CI 1.6-20.2).
Bleeding history: odds ratio 7.0 (95% CI 2.0-26.4).
Background
The study was motivated by the limitation that HVPG does not accurately reflect portal pressure in patients with PVT, and it evaluated EUS-PPG as an alternative.
The aim was to evaluate EUS-guided PPG in cirrhotic patients with PVT.
Pressure gradients from different measurement methods were compared and correlated with clinical characteristics.
Conclusions
The authors conclude that Dis-PVT PPG may be a preferred index of portal hypertension status in cirrhotic patients with PVT.
It is associated with bleeding history of GEV.
Conclusion is based on agreement with GVPG and associations with bleeding history and red sign.
What This Means
In people with cirrhosis, pressure in the portal vein (which carries blood to the liver) is often high, and doctors usually estimate it with a catheter measurement called HVPG. When a blood clot (portal vein thrombosis) is present, HVPG does not reflect portal pressure accurately. This study tested an alternative: using endoscopic ultrasound to guide a needle into blood vessels and measure pressure directly, both before and beyond the clot, and in stomach varices.
In 51 patients with cirrhosis, varices, and portal vein clots, the pressure measured beyond the clot (Dis-PVT PPG) agreed substantially with the pressure measured in gastric varices (ICC 0.693). Both measures were higher in patients who had previously bled from varices (about 17-18 mmHg vs. 7-11 mmHg). Patients with a Dis-PVT PPG of 12 mmHg or higher were more likely to have red signs on varices (OR 5.6) and a history of bleeding (OR 7.0).
This research suggests that measuring pressure beyond the clot with EUS may be a reliable way to gauge portal hypertension in this patient group. The study is fairly small and shows association with past bleeding rather than predicting future bleeding, so further research would be needed to confirm how useful the measure is in practice.
Wei W, Chen L, Ying R, Xue M. (2026). EUS-PPG Measured Distal to the Thrombus: A Reliable Way to Detect the Pressure Gradient in Patients With Cirrhosis and Portal Vein Thrombosis.. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. https://doi.org/10.1111/den.70325