Prehepatic Portal Hypertension
Conditions
Brief summary
Portal hypertension caused by prehepatic vascular obstruction, such as portal vein thrombosis or portal vein tumor thrombosis, represents a unique hemodynamic condition in which conventional hepatic venous pressure gradient (HVPG) measurement may not accurately reflect portal venous pressure. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement provides a direct approach for assessing portal hemodynamics. This retrospective observational study included patients with cirrhosis and esophagogastric varices complicated by portal vein thrombosis or portal vein tumor thrombosis. All patients underwent abdominal computed tomography to confirm the presence of portal vein obstruction, liver stiffness measurement by ultrasound elastography, HVPG measurement, and EUS-PPG measurement. The study aims to evaluate the relationship between EUS-PPG and HVPG and to explore the associations between portal pressure measurements and clinical characteristics, including underlying liver disease etiology, liver function grade, sex, gastrointestinal bleeding, and hepatic encephalopathy.
Interventions
None listed
Sponsors
Second Affiliated Hospital, Zhejiang University, School of Medicine
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Age ≥18 years; Confirmed diagnosis of cirrhosis complicated by portal venous obstructionbased on clinical, laboratory, and imaging findings; Written informed consent;
Exclusion criteria
Severe coagulopathy, defined as an International Normalized Ratio (INR) \>1.5; Severe thrombocytopenia, defined as a platelet count \<30 × 10\^9/L; Severe systemic comorbidities, including active sepsis, decompensated heart failure, or severe chronic obstructive pulmonary disease; Psychiatric or cognitive disorders that preclude cooperation with study procedures; Refusal to undergo hepatic venous pressure gradient (HVPG) or endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between EUS-Guided Portal Pressure Gradient and Hepatic Venous Pressure Gradient | Periprocedural | The correlation between portal pressure gradient measured by endoscopic ultrasound-guided direct portal pressure measurement (EUS-PPG) and hepatic venous pressure gradient (HVPG) will be assessed using paired measurements obtained during the same procedural session. Both EUS-PPG and HVPG are measured in mmHg. The strength of the correlation will be quantified using a correlation coefficient. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference Between Distal-to-Obstruction and Proximal-to-Obstruction EUS-Guided Portal Pressure Gradients | Periprocedural | The difference between distal-to-obstruction portal pressure gradient (dis-Obs PPG) and proximal-to-obstruction portal pressure gradient (pro-Obs PPG), measured by endoscopic ultrasound-guided direct portal pressure measurement, will be assessed using paired measurements obtained during the same procedural session. Both pressure gradients are measured in mmHg. |
| Difference Between Distal-to-Obstruction EUS-Guided Portal Pressure Gradient and Hepatic Venous Pressure Gradient | Periprocedural | The difference between distal-to-obstruction portal pressure gradient (dis-Obs PPG), measured by endoscopic ultrasound-guided direct portal pressure measurement, and hepatic venous pressure gradient (HVPG), measured by standard hepatic venous catheterization, will be assessed using paired measurements obtained during the same procedural session. Both pressure gradients are measured in mmHg. |
| Difference in Distal-to-Obstruction EUS-Guided Portal Pressure Gradient Between Patients With and Without Variceal Bleeding | Baseline | Distal-to-obstruction portal pressure gradient (dis-Obs PPG), measured by endoscopic ultrasound-guided direct portal pressure measurement and expressed in mmHg, will be compared between patients with and without variceal bleeding related to portal hypertension. |
Countries
China
Outcome results
None listed