Skip to main content
SpringerLink
Log in

Endoscopic Ultrasound-Guided Portal Pressure Measurement

  • Chapter
  • First Online:
Interventional Endoscopic Ultrasound

  • 737 Accesses

Abstract

A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization due to the relative proximity of the gastrointestinal tract to the major blood vessels of the mediastinum and abdomen. In particular, EUS-guided access of the portal vein (PV) may be favorable given the relative difficulty of PV access via standard percutaneous routes. Two major diagnostic applications of EUS-guided vascular access include angiography and assessment of intravascular pressure. This review will outline the different devices and techniques employed to obtain angiographic visualization and/or direct pressure measurements of the portal circulation. Ease of access, safety, and important lessons learned from each approach will be highlighted.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lai L, Poneros J, Santilli J, Brugge W. EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility. Gastrointest Endosc. 2004;59(2):280–3.

    Article  Google Scholar 

  2. Magno P, Ko CW, Buscaglia JM, Giday SA, Jagannath SB, Clarke JO, et al. EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system. Gastrointest Endosc. 2007;66(3):587–91.

    Article  Google Scholar 

  3. Giday SA, Ko CW, Clarke JO, Shin EJ, Magno P, Jagannath SB, et al. EUS-guided portal vein carbon dioxide angiography: a pilot study in a porcine model. Gastrointest Endosc. 2007;66(4):814–9.

    Article  Google Scholar 

  4. Giday SA, Clarke JO, Buscaglia JM, Shin EJ, Ko CW, Magno P, et al. EUS-guided portal vein catheterization: a promising novel approach for portal angiography and portal vein pressure measurements. Gastrointest Endosc. 2008;67(2):338–42.

    Article  Google Scholar 

  5. Brugge WR. EUS is an important new tool for accessing the portal vein. Gastrointest Endosc. 2008;67(2):343–4.

    Article  Google Scholar 

  6. Hawkins IF, Caridi JG. Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol. 1998;8(3):391–402.

    Article  CAS  Google Scholar 

  7. Liss P, Eklof H, Hellberg O, Hagg A, Bostrom-Ardin A, Lofberg AM, et al. Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study. J Vasc Interv Radiol. 2005;16(1):57–65.

    Article  Google Scholar 

  8. Bosch J, Garcia-Pagan JC, Berzigotti A, Abraldes JG. Measurement of portal pressure and its role in the management of chronic liver disease. Semin Liver Dis. 2006;26(4):348–62.

    Article  Google Scholar 

  9. Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990;99(5):1401–7.

    Article  CAS  Google Scholar 

  10. Albillos A, Banares R, Gonzalez M, Ripoll C, Gonzalez R, Catalina MV, et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol. 2007;102(5):1116–26.

    Article  Google Scholar 

  11. D’Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131(5):1611–24.

    Article  Google Scholar 

  12. Perello A, Escorsell A, Bru C, Gilabert R, Moitinho E, Garcia-Pagan JC, et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999;30(6):1393–7.

    Article  CAS  Google Scholar 

  13. Tsushima Y, Koizumi J, Yokoyama H, Takeda A, Kusano S. Evaluation of portal pressure by splenic perfusion measurement using dynamic CT. AJR Am J Roentgenol. 1998;170(1):153–5.

    Article  CAS  Google Scholar 

  14. Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol. 2014;20(1):6–14.

    Article  Google Scholar 

  15. Thalheimer U, Bellis L, Puoti C, Burroughs AK. Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. Eur J Intern Med. 2011;22(1):5–7.

    Article  Google Scholar 

  16. Sarin SK, Khanna R. Non-cirrhotic portal hypertension. Clin Liver Dis. 2014;18(2):451–76.

    Article  Google Scholar 

  17. Pomier-Layrargues G, Kusielewicz D, Willems B, Villeneuve JP, Marleau D, Cote J, et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis. Hepatology. 1985;5(3):415–8.

    Article  CAS  Google Scholar 

  18. Buscaglia JM, Shin EJ, Clarke JO, Giday SA, Ko CW, Thuluvath PJ, et al. Endoscopic retrograde cholangiopancreatography, but not esophagogastroduodenoscopy or colonoscopy, significantly increases portal venous pressure: direct portal pressure measurements through endoscopic ultrasound-guided cannulation. Endoscopy. 2008;40(8):670–4.

    Article  CAS  Google Scholar 

  19. Schulman AR, Thompson CC, Ryou M. EUS-guided portal pressure measurement using a digital pressure wire with real-time remote display: a novel, minimally invasive technique for direct measurement in an animal model. Gastrointest Endosc. 2016;83(4):817–20.

    Article  Google Scholar 

  20. Schulman AR, Thompson CC, Ryou M. Endoscopic ultrasound-guided direct portal pressure measurement using a digital pressure wire with real-time remote display: a survival study. J Laparoendosc Adv Surg Tech A. 2017;27(10):1051–4.

    Article  Google Scholar 

  21. Huang JY, Samarasena JB, Tsujino T, Chang KJ. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus standard transjugular approach: a comparison animal study. Gastrointest Endosc. 2016;84(2):358–62.

    Article  Google Scholar 

  22. Fujii-Lau LL, Leise MD, Kamath PS, Gleeson FC, Levy MJ. Endoscopic ultrasound-guided portal-systemic pressure gradient measurement. Endoscopy. 2014;46(Suppl 1):E654–6.

    PubMed  Google Scholar 

  23. Huang JY, Samarasena JB, Tsujino T, Lee J, Hu KQ, McLaren CE, et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc. 2017;85(5):996–1001.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology,H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA, USA

    Jason B. Samarasena, Allen R. Yu & Kenneth J. Chang

Authors
  1. Jason B. Samarasena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allen R. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth J. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth J. Chang .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Douglas G. Adler, MD, FACG, AGAF, FASGE

Electronic Supplementary Material

Demonstration of a case of EUS-guided portal pressure gradient measurement (MP4 454141 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Samarasena, J.B., Yu, A.R., Chang, K.J. (2019). Endoscopic Ultrasound-Guided Portal Pressure Measurement. In: Adler, MD, FACG, AGAF, FASGE, D. (eds) Interventional Endoscopic Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-97376-0_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97376-0_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97375-3

  • Online ISBN: 978-3-319-97376-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation