Advertisement

Direct portal pressure gradient measurement in patients with porto-sinusoidal vascular disease

Published:November 11, 2022DOI:https://doi.org/10.1016/j.dld.2022.10.013
      Hepatic venous pressure gradient (HVPG) measurement represents the gold standard to evaluate the presence of portal hypertension (PH), defined by HVPG >5 mmHg [
      • de Franchis R.
      • Bosch J.
      • Garcia-Tsao G.
      • Reiberger T.
      • et al.
      Baveno VII - renewing consensus in portal hypertension.
      ]. Up to HVPG values <10 mmHg, patients have a negligible risk of developing PH-related complications of advanced chronic liver disease (ACLD). Conversely in those with HVPG >10 mmHg, which delineates clinically significant portal hypertension (CSPH), the risk of developing varices, variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatic encephalopathy  increases exponentially [
      • Garcia-Tsao G.
      • Groszmann R.J.
      • Fisher R.L.
      • et al.
      Portal pressure, presence of gastroesophageal varices and variceal bleeding.
      ]. HVPG measurement is, therefore, critical to monitor ACLD progression, stratify patient's prognosis, and assess effects of pre-emptive or therapeutic interventions. HVPG, however, is an indirect method of PH measurement, being performed outside the portal vein system. It reflects portal pressure gradient (PPG) and is highly reliable in sinusoidal forms of PH (e.g. viral- and alcohol-related cirrhosis), but not in pre-sinusoidal ones [
      • Seijo S.
      • Reverter E.
      • Miquel R.
      • et al.
      Role of hepatic vein catheterisation and transient elastography in the diagnosis of idiopathic portal hypertension.
      ]. This, indeed, is the case of porto-sinusoidal vascular disease (PSVD) [
      • De Gottardi A.
      • Rautou P.E.
      • Schouten J.
      • et al.
      Porto-sinusoidal vascular disease: proposal and description of a novel entity.
      ], characterized by histologic lesions encompassing portal venules and sinusoids, which is becoming increasingly recognized representing 3–7% of cases of PH in Western countries [
      • Barge S.
      • Grando V.
      • Nault J.C.
      • et al.
      Prevalence and clinical significance of nodular regenerative hyperplasia in liver biopsies.
      ,
      • Wanless I.R.
      Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules.
      . This disease interests the pre-sinusoidal site, rendering HVPG measurement unreliable, even in those patients with clear-cut clinical signs of CSPH (i.e. gastro-esophageal varices and porto-systemic collaterals) [
      • De Gottardi A.
      • Rautou P.E.
      • Schouten J.
      • et al.
      Porto-sinusoidal vascular disease: proposal and description of a novel entity.
      ].
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • de Franchis R.
        • Bosch J.
        • Garcia-Tsao G.
        • Reiberger T.
        • et al.
        Baveno VII - renewing consensus in portal hypertension.
        J Hepatol. 2022; 76 (AprEpub 2021 Dec 30. Erratum in: J Hepatol. 2022 Apr 14;: PMID: 35120736): 959-974https://doi.org/10.1016/j.jhep.2021.12.022
        • Garcia-Tsao G.
        • Groszmann R.J.
        • Fisher R.L.
        • et al.
        Portal pressure, presence of gastroesophageal varices and variceal bleeding.
        Hepatology. 1985; 5 (May-JunPMID: 3873388): 419-424https://doi.org/10.1002/hep.1840050313
        • Seijo S.
        • Reverter E.
        • Miquel R.
        • et al.
        Role of hepatic vein catheterisation and transient elastography in the diagnosis of idiopathic portal hypertension.
        Dig Liver Dis. 2012; 44 (OctEpub 2012 Jun 19. PMID: 22721839): 855-860https://doi.org/10.1016/j.dld.2012.05.005
        • De Gottardi A.
        • Rautou P.E.
        • Schouten J.
        • et al.
        Porto-sinusoidal vascular disease: proposal and description of a novel entity.
        Lancet Gastroenterol Hepatol. 2019; 4 (MayPMID: 30957754): 399-411https://doi.org/10.1016/S2468-1253(19)30047-0
        • Barge S.
        • Grando V.
        • Nault J.C.
        • et al.
        Prevalence and clinical significance of nodular regenerative hyperplasia in liver biopsies.
        Liver Int. 2016; 36 (JulEpub 2015 Oct 19. PMID: 26415006): 1059-1066https://doi.org/10.1111/liv.12974
        • Wanless I.R.
        Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules.
        Hepatology. 1990; 11: 787-797
        • Choi A.Y.
        • Kolb J.
        • Shah S.
        • et al.
        Endoscopic ultrasound-guided portal pressure gradient with liver biopsy: 6 years of endo-hepatology in practice.
        J Gastroenterol Hepatol. 2022; 37 (JulEpub 2022 May 20. PMID: 35513894): 1373-1379https://doi.org/10.1111/jgh.15875
        • Huang J.Y.
        • Samarasena J.B.
        • Tsujino T.
        • et al.
        EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.
        Gastrointest Endosc. 2017; 85 (MayEpub 2016 Sep 29. PMID: 27693644; PMCID: PMC5611853): 996-1001https://doi.org/10.1016/j.gie.2016.09.026
        • Ferrusquía-Acosta J.
        • Bassegoda O.
        • Turco L.
        • et al.
        Agreement between wedged hepatic venous pressure and portal pressure in non-alcoholic steatohepatitis-related cirrhosis.
        J Hepatol. 2021; 74 (AprEpub 2020 Oct 14. PMID: 33068638): 811-818https://doi.org/10.1016/j.jhep.2020.10.003
        • Reverter E.
        • Blasi A.
        • Abraldes J.G.
        • et al.
        Impact of deep sedation on the accuracy of hepatic and portal venous pressure measurements in patients with cirrhosis.
        Liver Int. 2014; 34 (JanEpub 2013 Jun 13. PMID: 23763484): 16-25https://doi.org/10.1111/liv.12229