Advances in the diagnosis and management of clinically significant portal hypertension in cirrhosis: A narrative review

Figure 1 Pathophysiology of cirrhosis. ADH: Antidiuretic hormone; NH3: Ammonia; RAAS: Renin-angiotensin-aldosterone system; VEGF: Vascular endothelial growth factor.

Figure 2 Hepatic vein pressure gradient measurement. IVC: Inferior vena cava; LHV: Left hepatic vein; LPV: Left portal vein; MHV: Middle hepatic vein; PV: Portal vein; RHV: Right hepatic vein; RPV: Right portal vein.

Figure 3 A schematic summary of the rule of five from the BAVENO VII consensus. BMI: Body mass index; cACLD: Compensated advanced chronic liver disease; CSPH: Clinically significant portal hypertension; MASLD: Metabolic dysfunction-associated steatotic liver disease.

Figure 4 A proposed algorithm for clinically significant portal hypertension screening. BMI: Body mass index; CSPH: Clinically significant portal hypertension; LSM: Liver stiffness measurement; MASLD: Metabolic dysfunction-associated steatotic liver disease; SSM: Spleen measurement; HVPG: Hepatic vein pressure gradient; EUS-PPG: Endoscopic ultrasound-guided portal pressure gradient.

Figure 5 Endoscopic ultrasound-guided portal pressure gradient. EUS: Endoscopic ultrasound; HVP: Hepatic vein pressure; IVC: Inferior vena cava; LHV: Left hepatic vein; LPV: Left portal vein; MHV: Middle hepatic vein; RHV: Right hepatic vein; RPV: Right portal vein; PPG: Portal pressure gradient; PVP: Portal vein pressure.

Figure 6 Sarin classification of varices adapted. CYA: Cyanoacrylate; EV: Esophageal varices; GEV: Gastric epiploic vein; GOV 1: Gastro-esophageal varices type 1; GOV 2: Gastro-esophageal varices type 2; IGV 1: Isolated gastric varices type 1; IGV 2: Isolated gastric varices type 2; LGV: Left gastric vein; PGV: Posterior gastric vein; PV: Portal vein; SGV: Short gastric vein; SV: Splenic vein.

Figure 7 Transjugular intrahepatic portosystemic shunt. HV: Hepatic vein; IVC: Inferior vena cava; PV: Portal vein.