Endoscopic ultrasound-guided portosystemic pressure gradient measurement vs. transjugular balloon occlusion measurement in patients with cirrhosis (ENCOUNTER):A bicentric EU study

Background &amp; Aims: Patients with cirrhosis and portal hypertension are at increased risk of hepatic decompensation and liver-related mortality. While the hepatic venous pressure gradient (HVPG) is the accepted method for quantifying portal hypertension, its measurement and limited availability pose challenges. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) provides a direct alternative. The ENCOUNTER study is the first to compare EUS-PPG to HVPG in the same patient, simultaneously. Methods: This prospective, international, bicentric study included patients referred for HVPG or transjugular intrahepatic portosystemic shunt (TIPS) placement at the University Hospital of Leuven (Belgium) and Hospital Clinic Barcelona (Spain). Patients underwent standard-of-care HVPG, followed by simultaneous HVPG and EUS-PPG measurements under propofol general anesthesia. Results: The final analysis included 21 patients with cirrhosis undergoing simultaneous HVPG and EUS-PPG measurements, of whom 15 received TIPS. Mean HVPG and EUS-PPG values under general anesthesia were comparable (11.9 ± 5.2 vs. 10.9 ± 5.6 mmHg, p = 0.2332) and showed good correlation (r = 0.74, p = 0.0001). The individual pressure components also showed a good correlation (portal vein: r = 0.85, p &lt;0.0001; hepatic vein: r = 0.72, p = 0.0003). In patients receiving TIPS, direct transjugular portal pressure measurements demonstrated an excellent correlation with EUS-guided portal pressures (r = 0.91, p &lt;0.0001). Technical success was achieved in all cases, with no adverse events associated with the EUS-PPG procedure. Conclusion: EUS-PPG is a reliable and safe alternative to HVPG for the direct measurement of portal pressure. However, attention must be paid to technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia, which may alter pressure measurements and subsequently affect risk classification. Impact and implications: The ENCOUNTER study is the first study to directly compare endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) with hepatic venous pressure gradient (HVPG) in the same patients, simultaneously. EUS-PPG is a safe and reliable direct alternative to HVPG for measuring portal pressure. However, technical challenges, including the potential overestimation of EUS-guided hepatic vein pressures and the impact of general anesthesia must be considered. EUS-PPG is particularly attractive for patients with chronic liver disease who have conflicting non-invasive test results, require additional endoscopic procedures, or in cases where HVPG may underestimate true portal pressure. ClinicalTrials.gov: NCT04987034.</p

Indications of endoscopic ultrasonography-guided fine needle aspiration (EUS FNA) in subepithelial tumors

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Upper gastrointestinal stenting during the SARS-CoV-2 outbreak: impact of mitigation measures and risk of contamination for patients and staff

Abstract Background and study aims The impact of COVID-19 mitigation measures on stent placement procedures has not yet been reported. The aim of this study was to assess the impact of COVID-19 mitigation measures on upper stenting during SARS-CoV-2 outbreak, as well as the use of personal protection equipment (PPE) and risk of contamination for patients and staff. Patients and methods This was a multicenter, retrospective study of consecutive patients who underwent stent placement for upper gastrointestinal obstruction during the second half of SARS-CoV-2 outbreak period in comparison to same period one year before. Results A total of 29 stents were placed for upper gastrointestinal obstruction during the study period, corresponding to an increase of 241 % comparing to the same period in 2019 (n = 12). No significant major differences were found between the two time periods regarding patients’ baseline characteristics, post-stenting management and number of staff involved in stent placement. Fellows’ involvement was significantly lower in 2020 compared to 2019 (21 % vs 67 %; P = 0.01). The majority of procedures were performed using FFP2 /FFP3 mask (76 %), protective eyewear (86 %), two pairs of gloves (65 %), hairnet (76 %) and full disposable gowns (90 %). One patient tested positive for SARS-CoV-2 after the procedure. None of the medical staff involved in stenting procedures developed COVID-19 14 days after procedure. Conclusion Upper gastrointestinal stenting increased during the SARS-CoV-2 outbreak period, which could be related to yearly variation on the number of procedures or reflect a change of oncologic treatment practice during COVID times.</jats:p