Singla N, Shantan V, Saraswat A, Singh AP. Advances in portal pressure measurement: Endoscopic techniques, challenges, and implications for liver transplantation. World J Hepatol 2025; 17(8): 107679 [DOI: 10.4254/wjh.v17.i8.107679]
Corresponding Author of This Article
Neeraj Singla, MD, Consultant, DM, Researcher, Department of Medical Gastroenterology, Fortis Hospitals, Chandigarh Road, Ludhiana 141123, Punjab, India. dr.neerajsingla@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Neeraj Singla, Department of Medical Gastroenterology, Fortis Hospitals, Ludhiana 141123, Punjab, India
Venishetty Shantan, Department of Hepatology, AIG Hospitals, Hyderabad 500032, Telangāna, India
Anushka Saraswat, Symbiosis Medical College for Women, Pune 412115, Mahārāshtra, India
Aniruddha Pratap Singh, Department of Gastroenterology, AIG Hospitals, Hyderabad 500032, Telangāna, India
Author contributions: Singla N and Shantan V contributed to conceptualization, writing original draft, and revision; Saraswat A and Singh AP contributed to methodology, assisted in the conceptualization, and contributed to the images and references; all authors read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Neeraj Singla, MD, Consultant, DM, Researcher, Department of Medical Gastroenterology, Fortis Hospitals, Chandigarh Road, Ludhiana 141123, Punjab, India. dr.neerajsingla@gmail.com
Received: April 1, 2025 Revised: May 9, 2025 Accepted: July 14, 2025 Published online: August 27, 2025 Processing time: 151 Days and 21 Hours
Abstract
Portal hypertension is a critical determinant of prognosis in chronic liver disease and a key factor in evaluating candidates for liver transplantation. Traditional methods such as hepatic venous pressure gradient (HVPG) measurement have long been considered the gold standard for assessing portal pressure. However, these methods are invasive and carry procedural limitations. Recent advances in endoscopic ultrasound (EUS)-guided techniques have emerged as promising alternatives, offering direct and minimally invasive assessment of portal pressure. EUS-guided portal pressure gradient measurement enables real-time evaluation of haemodynamic through direct access to the portal system. This technique has shown to be as accurate as HVPG, and it has some extra benefits, like the ability to take liver biopsies and check collateral circulation all at the same time. Despite these benefits, the technique poses challenges such as operator dependence, procedural complexity, and limited standardization across centres. This minireview highlights the evolution of portal pressure measurement, focusing on the potential of EUS-guided techniques in pre-transplant assessment, risk stratification, and monitoring therapeutic outcomes. Furthermore, it discusses the technical challenges, clinical implications, and future directions for integrating these innovations into routine practice. Advances in portal pressure measurement hold significant promise for enhancing decision-making and outcomes in liver transplantation.
Core Tip: The accurate measurement of portal hypertension (PH) is crucial in assessment of patients with liver cirrhosis as it significantly impacts the disease progression and prognosis. Moreover, it plays a critical role in guiding surgical decisions especially liver transplant. Hepatic vein pressure gradient is considered gold standard technique for measuring PH but is not widely used due to various factors like lack of availability, technical expertise, risk of contrast and ionizing radiation and inaccuracy in pre-sinusoidal causes of PH. Endoscopic ultrasound (EUS) has emerged as a safe and reliable method for portal pressure measurement. The portal pressure gradient (PPG) can be estimated as a single procedure while evaluating for collaterals including oesophageal and gastric varices or while doing a liver biopsy. With increase in cases of liver transplant in future, EUS guided PPG might play a crucial role in peri-operative and post-operative management of such patients.
