Telbany A, Soliman Y, Singh G, Abouelezz K, Kachaamy T. Role of endoscopic ultrasound-guided portal pressure gradient measurement in assessing liver function before liver-directed therapies. World J Gastrointest Surg 2025; 17(9): 101834 [DOI: 10.4240/wjgs.v17.i9.101834]
Corresponding Author of This Article
Toufic Kachaamy, AGAF, FACG, FASGE, Department of Gastroenterology, City of Hope, Celebrate Life Way, Goodyear, Phoenix, AZ 85338, United States. tkachaamy@coh.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 101834 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.101834
Role of endoscopic ultrasound-guided portal pressure gradient measurement in assessing liver function before liver-directed therapies
Ahmed Telbany, Youssef Soliman, Gagandeep Singh, Khaled Abouelezz, Toufic Kachaamy
Ahmed Telbany, Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87106, United States
Youssef Soliman, Toufic Kachaamy, Department of Gastroenterology, City of Hope, Phoenix, AZ 85338, United States
Gagandeep Singh, Department of Surgery, City of Hope, Phoenix, AZ 85338, United States
Khaled Abouelezz, Department of Oncology, City of Hope, Phoenix, AZ 85338, United States
Author contributions: Telbany A led the conceptualization, writing, and overall development of the manuscript; Kachaamy T led the conceptualization, writing, and overall development of the manuscript; Soliman Y, Singh G, Abouelezz K contributed to the critical review, editing, and refinement of the content. All authors approved the final version of the manuscript.
Conflict-of-interest statement: Microtech, consultant and royalties Olympus, consultant Steris Endoscopy, consultant Medtronic, consultant Pentax, Consultant Grail speakers Bureau Cook Medical consultant Creomedical educational support Boston Scientific, educational support Exact Science food and beverage.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toufic Kachaamy, AGAF, FACG, FASGE, Department of Gastroenterology, City of Hope, Celebrate Life Way, Goodyear, Phoenix, AZ 85338, United States. tkachaamy@coh.org
Received: September 28, 2024 Revised: April 3, 2025 Accepted: May 13, 2025 Published online: September 27, 2025 Processing time: 361 Days and 8.5 Hours
Abstract
Liver-directed therapies such as resection, ablation, and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care. However, these treatments pose significant hepatic decompensation risks, particularly with underlying liver disease and chemotherapy-associated steatohepatitis. Accurate assessment of liver function and portal hypertension (PH) is critical for candidate selection. While Child-Pugh score and model for end-stage liver disease are commonly used, they have substantial limitations. Hepatic venous pressure gradient (HVPG) measurement remains the gold standard for assessing PH but is invasive and not widely available. Endoscopic ultrasound (EUS) guided portal pressure gradient (PPG) measurement has emerged as a promising minimally invasive alternative. EUS-PPG demonstrates excellent technical success rates, safety profile, and correlation with HVPG in early studies. By providing direct portal pressure measurement, EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies, particularly in detecting presinusoidal hypertension. Furthermore, it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies. However, research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.
Core Tip: Assessment of portal hypertension, hepatic steatosis and fibrosis provides valuable prognostic information prior to liver-directed therapies. Endoscopic ultrasound-guided portal pressure gradient is an exciting emerging technique that warrants further investigation as a potentially safer and more accessible alternative to trans-jugular hepatic venous pressure gradient measurement.
