Endoscopic ultrasound-guided portal pressure gradient measurement: a systematic review and meta-analysis.

Autor: Dhindsa BS; Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine (Banreet Singh Dhindsa)., Tun KM; Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, Nevada (Kyaw Min Tun)., Fiedler A; Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Alexandra Fiedler, Kyle Scholten, Ishfaq Bhat, Shailender Singh)., Deliwala S; Division of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, Georgia (Smit Deliwala)., Saghir SM; Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska (Syed Mohsin Saghir, Saurabh Chandan)., Scholten K; Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Alexandra Fiedler, Kyle Scholten, Ishfaq Bhat, Shailender Singh)., Ramai D; Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Daryl Ramai)., Girotra M; Digestive Health Institute, Swedish Medical Center, Seattle, Washington (Mohit Girotra).; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington (Mohit Girotra)., Chandan S; Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska (Syed Mohsin Saghir, Saurabh Chandan)., Dhaliwal A; McLeod Health, Florence, South Carolina (Amaninder Dhaliwal)., Bhat I; Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Alexandra Fiedler, Kyle Scholten, Ishfaq Bhat, Shailender Singh)., Singh S; Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Alexandra Fiedler, Kyle Scholten, Ishfaq Bhat, Shailender Singh)., Adler DG; Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO (Douglas G. Adler), USA.
Jazyk: angličtina
Zdroj: Annals of gastroenterology [Ann Gastroenterol] 2024 May-Jun; Vol. 37 (3), pp. 356-361. Date of Electronic Publication: 2024 Apr 29.
DOI: 10.20524/aog.2024.0882
Abstrakt: Background: Endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPG) is a new modality where the portal pressure is measured by directly introducing a needle into the hepatic vein and portal vein. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of EUS-PPG.
Methods: A comprehensive literature search was performed to identify pertinent studies. The primary outcomes assessed were the technical and clinical success of EUS-PPG. Technical success was defined as successful introduction of the needle into the desired vessel, while clinical success was defined as the correlation of the stage of fibrosis on the liver biopsy to EUS-PPG, or concordance of HVPG and EUS-PPG. The secondary outcomes were pooled rates for total and individual adverse events related to EUS-PPG. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI).
Results: Eight cohort studies with a total of 178 patients were included in our analysis. The calculated pooled rates of technical success and clinical success were 94.6% (95%CI 88.5-97.6%; P=<0.001; I 2 =0) and 85.4% (95%CI 51.5-97.0%; P=0.042; I 2 =70), respectively. The rate of total adverse events was 10.9% (95%CI 6.5-17.7%; P=<0.001; I 2 =4), and 93.7% of them were mild, as defined by the American Society for Gastrointestinal Endoscopy. Abdominal pain (11%) was the most common adverse event, followed by bleeding (3.6%). There were no cases of perforation or death reported in our study.
Conclusions: EUS-PPG is a safe and effective modality for diagnosing portal hypertension. Further randomized controlled trials are needed to validate our findings.
Competing Interests: Conflict of Interest: None
(Copyright: © Hellenic Society of Gastroenterology.)
Databáze: MEDLINE
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