Endoscopic Ultrasound Guided Liver Biopsy And Portal Pressure Gradient Measurement Compared To The Transjugular Approach: A Randomized Controlled Trial
Notice bibliographique
Résumé
Aims The transjugular (TJ) technique is the gold standard to simultaneously evaluate portal hypertension and liver fibrosis, with the hepatic venous pressure gradient (HVPG) and liver biopsy (LB), respectively. Recently, Endoscopic Ultrasound (EUS) has emerged as a novel approach capable of measuring portal pressure gradient (PPG) and performing LB. We hypothesize that EUS will yield higher-quality LB than TJ and also provide reliable PPG measurements. To date, no randomized controlled trial (RCT) has compared EUS to TJ. Methods This single center RCT included adults evaluated for liver fibrosis and portal hypertension. Participants were randomly assigned to EUS or TJ for simultaneous HVPG/PPG and LB. The TJ technique was performed as per standard of care (low-dose midazolam, 18G TJ-LB system, and balloon wedge-pressure catheter). EUS was performed under conscious sedation with ketamine and low-dose midazolam. EUS-PPG was done using a 25G needle (EchoTip Insight, Cook Medical) and LB with a 19G needle (Acquire, Boston Scientific). The primary endpoint was the proportion of high-quality LB (AASLD criteria:≥25mm total aggregate length and≥11 complete portal tracts using 2 or 3 passes) with consistent HVPG/PPG (duplicate or triplicate measures within≤1mmHg). Secondary endpoints included technical success (obtaining a LB and HVPG/PPG), procedure time, LB- and HVPG/PPG-related outcomes, adverse events (AE, ASGE grading at day 7) and patient satisfaction (patient sedation satisfaction instrument, PSSI). We conducted an intent-to-treat analysis, reporting n (%) and mean (SD), with statistical significance defined as a two-tailed p-value≤0.05. Results A total of 58 patients were randomized, 29 to EUS and 29 to TJ (56.6 [14.7] years old, 37.9% female, 50% MASLD, 67.2% cirrhosis). The primary endpoint was met in 24 (82.8%) patients for EUS vs 12 (41.4%) patients for TJ (p<0.01). Technical success occurred in 26 (90.0%) patients for EUS vs 28 (96.6%) patients for TJ (p=0.61). The procedure time was 20.7 (4.8) minutes for EUS and 48.8 (14.0) minutes for TJ (p<0.01). Mean total aggregate length was EUS: 117 (83.7) mm vs TJ: 29.2 (9.5) mm (p<0.01), complete portal tracts per specimen: EUS: 29.2 (18.7) vs TJ: 11.2 (5.8) (p<0.01), maximal length of single core: EUS: 25.3 (17.1) mm vs TJ: 13.6 (3.8) mm (p<0.01), number of passes: EUS: 2.1 (0.3) vs TJ: 2.3 (0.5) (p=0.02). Reliable HVPG/PPG was obtained in 26 (89.7%) patients for EUS vs 17 (58.6%) patients for TJ (p<0.01). All AEs were mild, including 2 (6.9%) for EUS and 3 (10.3%) in TJ. As per PSSI, total patient satisfaction with sedation was higher for EUS (p<0.01). Conclusions While both procedures had similar technical success and safety profile, EUS is superior to TJ for the simultaneous acquisition of high-quality LB, consistent PPG, and patient satisfaction with sedation. In the well-selected cases, EUS is therefore preferable to TJ, paving the way for a significant shift in practice. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,004 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».