Gastric variceal pressure gradient in patients with large spontaneous shunts: A novel approach to local hemodynamic assessment

doi:10.3748/wjg.121668

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 7, 2026; 32(41): 121668
Published online Nov 7, 2026. doi: 10.3748/wjg.121668

Gastric variceal pressure gradient in patients with large spontaneous shunts: A novel approach to local hemodynamic assessment

Wei Wei, Meng Xue, Li-Yi Xu

Wei Wei, Meng Xue, Li-Yi Xu, Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China

Co-first authors: Wei Wei and Meng Xue.

Author contributions: Wei W conceived and designed the study, obtained funding, developed the methodology, curated the data, and drafted the manuscript; Xue M contributed to the study design, curated the data, supervised the study, and participated in manuscript preparation; Xu LY curated the data, performed the formal analysis, and critically revised the manuscript; Wei W and Xue M contributed equally to this work and share first authorship; all authors have read and approved the final manuscript.

AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Supported by the Chronic Disease Management Research Project of National Health Commission Capacity Building and Continuing Education Center, No. GWJJMB202510025159; and the Medical and Health Science Program of Zhejiang Province, No. 2025HY0403.

Institutional review board statement: The study was approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (approval No. 2025-0822).

Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: No additional data are available.

Corresponding author: Li-Yi Xu, MD, Doctor, Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China. xuly2016@zju.edu.cn

Received: April 9, 2026
Revised: June 23, 2026
Accepted: July 15, 2026
Published online: November 7, 2026
Processing time: 164 Days and 9.9 Hours

Abstract

BACKGROUND

The hepatic venous pressure gradient (HVPG) is a widely used metric to assess portal hypertension and predict the risk for variceal bleeding. However, in patients with cirrhosis and large spontaneous portosystemic shunts (SPSS), portal decompression may reduce intrahepatic pressure gradients and lead to an underestimation of local variceal hemodynamic stress.

AIM

To evaluate portal and variceal pressure characteristics in patients with cirrhosis and fundal varices and large SPSS.

METHODS

This retrospective, single-center study included data from patients with cirrhosis and gastric varices and large SPSS. All patients underwent simultaneous measurement of HVPG, endoscopic ultrasound-guided portal pressure gradient (PPG), and direct gastric variceal pressure (GVP). The GVP gradient (GVPG) was defined as the difference between GVP and inferior vena cava pressure. Patients were stratified according to the presence of variceal bleeding within 4 weeks. Correlation, Bland-Altman, and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS

Data from 25 patients were analyzed. The mean GVP was significantly higher than portal vein pressure (PVP) (27.04 ± 7.67 mmHg vs 19.84 ± 7.94 mmHg) and GVP was strongly correlated with PVP. The GVPG was substantially higher than both HVPG and PPG (P < 0.001). Although correlation analyses revealed significant associations among HVPG, PPG, and GVPG, agreement analyses indicated substantial variability, suggesting that they were not interchangeable. Among these parameters, only GVPG differed significantly between patients with and without recent bleeding (18.40 ± 6.07 mmHg vs 13.20 ± 5.13 mmHg; P = 0.030), whereas HVPG and PPG exhibited no significant differences. ROC curve analysis revealed that GVPG had moderate discriminatory ability for recent bleeding (area under the ROC curve = 0.760).

CONCLUSION

In patients with cirrhosis and SPSS, conventional HVPG and PPG may underestimate local variceal pressure whereas GVPG may facilitate assessment of bleeding risk, thus meriting prospective multicenter validation.

Keywords: Gastric varices; Spontaneous portosystemic shunt; Endoscopic ultrasound; Variceal pressure measurement; Hepatic venous pressure gradient; Gastric variceal pressure gradient

Core Tip: In patients with large spontaneous portosystemic shunts, the hepatic venous pressure gradient may underestimate the risk of bleeding because of shunt-mediated decompression. The gastric variceal pressure gradient, reflecting local variceal hemodynamics, may provide additional value for risk stratification.