EUS-Guided Liver Biopsy and Portal Pressure Measurement Compared With a Transjugular Approach: A Randomized Controlled Trial.
| Title: | EUS-Guided Liver Biopsy and Portal Pressure Measurement Compared With a Transjugular Approach: A Randomized Controlled Trial. |
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| Authors: | Benmassaoud A; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada. Electronic address: amine.benmassaoud@mcgill.ca.; Bessissow A; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Samoukovic G; Department of Surgery, McGill University Health Centre, Montreal, Canada.; Wong P; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; Zhao X; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; Deschenes M; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; Sebastiani G; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada.; Cabrera T; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Valenti D; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Boucher LM; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Pelage JP; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Muchantef K; Division of Interventional Radiology, McGill University Health Centre, Montreal, Canada.; Cardenas A; Gastroenterology and Liver Transplant Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic and University of Barcelona, Spain. Ciber de Enfermedades Hepáticas y Digestivas, Spain and Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona Spain.; Givis MA; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; White S; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; Bousquet-Dion G; Department of Anesthesia, McGill University Health Centre, Montreal, Canada.; Waked C; Research Institute of the McGill University Health Centre, Montreal, Canada.; Jacques J; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Service d'hépato-gastroentérologie, Centre Hospitalier Universitaire Dupuytren, Limoges, France.; Rahme E; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada.; Geraci O; Research Institute of the McGill University Health Centre, Montreal, Canada.; Martel M; Research Institute of the McGill University Health Centre, Montreal, Canada.; Barkun A; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.; Maedler-Kron C; Department of Pathology, McGill University Health Centre, Montreal, Canada.; Chen YI; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada. |
| Source: | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2025 Oct 03. Date of Electronic Publication: 2025 Oct 03. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: W.B. Saunders for the American Gastroenterological Association Country of Publication: United States NLM ID: 101160775 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1542-7714 (Electronic) Linking ISSN: 15423565 NLM ISO Abbreviation: Clin Gastroenterol Hepatol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003- |
| Abstract: | Background & Aims: The transjugular (TJ) technique is recommended for the simultaneous evaluation of portal hypertension and hepatic fibrosis, with the hepatic venous pressure gradient (HVPG) and liver biopsy (LB), respectively. Unfortunately, technical challenges have restricted access to HVPG, and TJ LB is often of suboptimal quality. Endoscopic ultrasound (EUS) is a novel approach capable of obtaining portal pressure gradient (PPG) and LB. Our aim was to compare EUS-guided PPG LB with TJ HVPG LB.; Methods: Patients with chronic liver disease simultaneously evaluated for portal hypertension and liver fibrosis at the McGill University Health Centre were randomly assigned to EUS-guided PPG LB or TJ HVPG LB. The primary endpoint was the combination of adequate LB (guideline recommendation: ≥25 mm total length and ≥11 complete portal tracts) and reliable HVPG/PPG (expert consensus: 2 measures within ≤1 mm Hg). Secondary endpoints assessed technical success, LB quality, HVPG/PPG reliability, patient satisfaction, and adverse events. Intention-to-treat analyses were conducted.; Results: Fifty-eight patients were randomized; 29 were EUS and 29 were TJ. Technical success was 90.0% for EUS and 96.6% for TJ (relative risk [RR], 0.93; 95% confidence interval [CI], 0.81-1.07). Combined adequate LB and reliable HVPG/PPG was 82.8% for EUS and 41.4% for TJ (RR, 2.00; 95% CI, 1.26-3.18). Proportion of adequate LB was 93.1% for EUS and 41.4% for TJ (RR, 2.25; 95% CI, 1.44-3.51). Proportion of reliable HVPG/PPG was 89.7% for EUS and 58.6% for TJ (RR, 1.53; 95% CI, 1.10-2.13).We found no between-group difference in adverse events.; Conclusions: EUS is superior to TJ for simultaneous acquisition of adequate LB and reliable PPG, suggesting that it has an important role in evaluating chronic liver diseases.; Clinicaltrials: gov, Number: NCT05118308.; (Copyright © 2025 AGA Institute. Published by Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: Endoscopy; Liver Biopsy; Portal Hypertension; Portal Pressure Gradient |
| Molecular Sequence: | ClinicalTrials.gov NCT05118308 |
| Entry Date(s): | Date Created: 20251005 Latest Revision: 20251104 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.cgh.2025.09.025 |
| PMID: | 41046961 |
| Database: | MEDLINE |
Journal Article