Standardized HVPG measurement: call for action

Li, Lei; Liu, Shanghao; Wu, Hao; Qi, Xiaolong

doi:10.1007/s12072-022-10367-y

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…WHVP can be measured using two methods: Measuring the pressure after the balloon blocks the hepatic vein or obtaining the pressure by inserting an end-hole catheter into the end of the branch of the hepatic vein. The former method is more accurate and is commonly used[ 13 ]. In normal liver hemodynamics, PVP is equal to or greater than the hepatic sinus pressure, WHVP is equal to the hepatic sinus pressure, and FHVP is 0.5–1.0 mmHg higher than IVCP[ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

Zhang,

Wang,

Yue

et al. 2023

World J Gastrointest Surg

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BACKGROUND Portal hypertension (PHT) in patients with alcoholic cirrhosis causes a range of clinical symptoms, including gastroesophageal varices and ascites. The hepatic venous pressure gradient (HVPG), which is easier to measure, has replaced the portal venous pressure gradient (PPG) as the gold standard for diagnosing PHT in clinical practice. Therefore, attention should be paid to the correlation between HVPG and PPG. AIM To explore the correlation between HVPG and PPG in patients with alcoholic cirrhosis and PHT. METHODS Between January 2017 and June 2020, 134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt procedures. Correlations were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient (r) and determination coefficient (R2). Bland-Altman plots were constructed to further analyze the agreement between the measurements. Disagreements were analyzed using paired t tests, and P values < 0.05 were considered statistically significant. RESULTS In this study, the correlation coefficient (r) and determination coefficient (R2) between HVPG and PPG were 0.201 and 0.040, respectively (P = 0.020). In the 108 patients with no collateral branch, the average wedged hepatic venous pressure was lower than the average portal venous pressure (30.65 ± 8.17 vs. 33.25 ± 6.60 mmHg, P = 0.002). Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography (19.4%), while the average PPG was significantly higher than the average HVPG (25.94 ± 7.42 mmHg vs 9.86 ± 7.44 mmHg; P < 0.001). The differences between HVPG and PPG < 5 mmHg in the collateral vs no collateral branch groups were three cases (11.54%) and 44 cases (40.74%), respectively. CONCLUSION In most patients, HVPG cannot accurately represent PPG. The formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.

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Section: Discussionmentioning

confidence: 99%

Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

Zhang,

Wang,

Yue

et al. 2023

World J Gastrointest Surg

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“…In the assessment of portal pressure, the gold standard is the hepatic venous pressure gradient (HVPG, Table 2), a minimally invasive fluoroscopic technique that is measured by catheterizing the right jugular or femoral vein; clinically significant portal hypertension is greater than 10 mmHg. However, data suggests that HVPG may not always reflect the actual severity of portal hypertension [27,28]. Even though it can only be performed at advanced health centers, it has pivotal clinical utility in diagnosing portal hypertension and determining esophageal varices' endoscopic grade [29][30][31].…”

Section: Prediction and Early Detection Of Bleeding Esophageal Varice...mentioning

confidence: 99%

The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review

Murillo Pineda,

Siu Xiao,

Sanabria Herrera

et al. 2024

Cureus

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Esophageal varices (EVs), a significant complication of cirrhosis, present a considerable challenge in clinical practice due to their high risk of bleeding and associated morbidity and mortality. This manuscript explores the transformative role of artificial intelligence (AI) in the management of EV, particularly in enhancing diagnostic accuracy and predicting bleeding risks. It underscores the potential of AI in offering noninvasive, efficient alternatives to traditional diagnostic methods such as esophagogastroduodenoscopy (EGD). The complexity of EV management is highlighted, necessitating a multidisciplinary approach that includes pharmacological therapy, endoscopic interventions, and, in some cases, surgical options tailored to individual patient profiles. Additionally, the paper emphasizes the importance of integrating AI into medical education and practice, preparing healthcare professionals for the evolving landscape of medical technology. It projects a future where AI significantly influences the management of gastrointestinal bleeding, improving clinical decision-making, patient outcomes, and overall healthcare efficiency. The study advocates for a patient-centered approach in healthcare, balancing the incorporation of innovative technologies with ethical principles and the diverse needs of patients to optimize treatment efficacy and enhance healthcare accessibility.

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Standardized HVPG measurement: call for action

Cited by 2 publications

References 11 publications

Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review

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