Cosmas Rinaldi Adithya Lesmana, FACG, FACP, MD, PhD, Assistant Professor, Senior Lecturer, Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, JL. Diponegoro 71, Jakarta 10430, DKI, Indonesia. medicaldr2001id@yahoo.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/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1033-1039 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1033
Endoscopic ultrasound-guided portal pressure gradient measurement in managing portal hypertension
Cosmas Rinaldi Adithya Lesmana
Cosmas Rinaldi Adithya Lesmana, Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
Cosmas Rinaldi Adithya Lesmana, Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta 12950, DKI, Indonesia
Cosmas Rinaldi Adithya Lesmana, Gastrointestinal Cancer Center, MRCCC Siloam Semanggi Hospital, Jakarta 12930, DKI, Indonesia
Author contributions: Lesmana CRA conceptualized the idea and wrote the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
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: Cosmas Rinaldi Adithya Lesmana, FACG, FACP, MD, PhD, Assistant Professor, Senior Lecturer, Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, JL. Diponegoro 71, Jakarta 10430, DKI, Indonesia. medicaldr2001id@yahoo.com
Received: October 28, 2022 Peer-review started: October 28, 2022 First decision: November 14, 2022 Revised: November 30, 2022 Accepted: April 24, 2023 Article in press: April 24, 2023 Published online: June 27, 2023
Abstract
Portal hypertension (PH) is still a challenging clinical condition due to its silent manifestations in the early stage and needs to be measured accurately for early detection. Hepatic vein pressure gradient measurement has been considered as the gold standard measurement for PH; however, it needs special skill, experience, and high expertise. Recently, there has been an innovative development in using endoscopic ultrasound (EUS) for the diagnosis and management of liver diseases, including portal pressure measurement, which is commonly known as EUS-guided portal pressure gradient (EUS-PPG) measurement. EUS-PPG measurement can be performed concomitantly with EUS evaluation for deep esophageal varices, EUS-guided liver biopsy, and EUS-guided cyanoacrylate injection. However, there are still major issues, such as different etiologies of liver disease, procedural training, expertise, availability, and cost-effectiveness in several situations with regard to the standard management.
Core Tip: Portal hypertension (PH) is a challenging clinical condition due to its silent manifestations in the early stage. Hepatic vein pressure gradient measurement is still the gold standard for PH diagnosis; however, it is not recommended for a routine measurement in daily practice. Esophagogastroduodenoscopy is still the main procedure for variceal screening due to PH. Recently, there has been a development in using endoscopic ultrasound (EUS) for managing liver diseases. EUS-guided portal pressure gradient measurement seems to be a promising method in the future for early detection and management of PH.
