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World J Hepatol. Aug 27, 2025; 17(8): 107679
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.107679
Advances in portal pressure measurement: Endoscopic techniques, challenges, and implications for liver transplantation
Neeraj Singla, Venishetty Shantan, Anushka Saraswat, Aniruddha Pratap Singh
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
Core Tip

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.