Clin Endosc.  2018 May;51(3):222-228. 10.5946/ce.2018.079.

Endoscopic Ultrasound-Guided Portal Pressure Measurement and Interventions

Affiliations
  • 1Division of Gastroenterology and Hepatology, H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA, USA. jsamaras@uci.edu

Abstract

A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization. Potential clinical applications of EUS-guided portal venous access include angiography, measurement of the portosystemic pressure gradient, EUS-guided transhepatic intrahepatic portosystemic shunt creation and portal vein sampling for the evaluation in gastrointestinal cancer. The following article reviews the different devices and techniques employed in these applications.

Keyword

Endosonography; Portal pressure gradient; Hepatic venous portal gradient; Portal vein sampling; Transhepatic intrahepatic portosystemic shunt

MeSH Terms

Angiography
Endosonography
Gastrointestinal Neoplasms
Portal Pressure*
Portal Vein
Portasystemic Shunt, Surgical
Ultrasonography
Vascular Access Devices

Figure

  • Fig. 1. Compact manometer used for endoscopic ultrasound-guided portal pressure measurement (Cook Medical, Bloomington, IN, USA).

  • Fig. 2. Endoscopic ultrasound-guided portal pressure measurement apparatus showing non-compressible tubing attached to the fine needle aspiration needle inlet (right pane) and compact manometer being placed at the mid-axillary line of the patient (left pane).

  • Fig. 3. Endoscopic ultrasound image of needle puncture of middle hepatic vein with 25 G fine needle aspiration needle.

  • Fig. 4. Endoscopic ultrasound Doppler flow image of middle hepatic vein demonstrating multiphasic waveform.

  • Fig. 5. Endoscopic ultrasound image of needle puncture of left portal vein with 25 G fine needle aspiration needle.

  • Fig. 6. Endoscopic ultrasound Doppler flow image of left portal vein demonstrating typical waveform.


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