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Endoscopic ultrasound-guided portal pressure gradient assessment of acute hemodynamic response to intravenous propranolol

Year: 2026

Type: article

Abstract: The development of portal hypertension is a critical hallmark in chronic liver diseases. The hepatic venous pressure gradient (HVPG) is the gold-standard method to diagnose and quantify portal hypertension and the hemodynamic response to drug therapy. An acute hemodynamic response to intravenous propranolol assessed with the HVPG predicts adverse liver-related events [ 1 ]. However, the HVPG is not recommended in routine clinical care due to its drawbacks [ 2 ]. Non-invasive tests (NITs) are used in daily clinical practice to stratify the risk of clinically significant portal hypertension [ 2 ]. Nevertheless, NITs are not recommended for assessing hemodynamic changes in portal hypertension [ 2 ]. Moreover, there is a gray-zone where patients affected with metabolic associated liver diseases, obesity or mixed etiologies could be misclassified by NITs [ 3 ]. The endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPGm) has been accurately compared to the HVPG and can directly obtain the real portal vein pressure [ 4 ]. We determine the acute hemodynamic response to intravenous propranolol with EUS-PPGm in a case of a series of four patients ([ Table 1 ]). The procedure was performed as previously reported, taking into account several tips and tricks to avoid non-reliable results [ 5 ]. Table 1 Data and results. Patient Age Sex Etiology Child-Pugh MELD Liver stiffness (kPa) Platelets (g/L) EUS-PPGm before iv ropranolol EUS-PPGm after iv propranolol Abbreviation: EUS-PPGm, endoscopic ultrasound-guided portal pressure gradient measurement. 1 60 Male Alcohol B8 12 75 164.000 3 mmHg Not indicated 2 67 Female Alcohol A5 8 19 108.000 3.75 mmHg Not indicated 3 60 Male Metabolic A5 7 29 170.000 10.5 mmHg 4.75 mmHg (55% reduction) 4 65 Female Alcohol B9 11 26,5 147.000 10 mmHg 2 mmHg (80% reduction) Following baseline EUS-PPGm, 0.15 mg/kg of body weight, propranolol was administered intravenously by continuous infusion in 10 minutes. The second EUS-PPGm was repeated 15 minutes later targeting the same vessels with the same angle of the needle and position of the echoendoscope as in the baseline EUS-PPGm procedure ([ Video 1 ]). Download Video EUS-guided portal pressure gradient assessment of the acute hemodynamic response to intravenous propranolol.Video 1 A significant reduction of PPG in two patients ([ Fig. 1 ]), treated with intravenous propranolol, was observed (10.5 mmHg to 4.75 mmHg [55%] and 10 mmHg to 2 mmHg [80%], respectively). In the other two patients, the first EUS-PPGm was normal. So, a second EUS-PPG measurement was not performed avoiding further unnecessary therapy with beta-blockers. No adverse events were observed. Fig. 1 EUS-guided assessment of the portal pressure gradient after intravenous administration of propranolol. EUS, endoscopic ultrasound. EUS-PPGm can assess acute hemodynamic changes after intravenous administration of propranolol. Endoscopy_UCTN_Code_TTT_1AS_2AD Publication History Article published online: 13 January 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Source: Endoscopy

DOI: 10.1055/a-2764-4494