Endoscopic Diagnosis of Portal Hypertension

Portal hypertension (PH), resulting from increased resistance of hepatic sinusoids to blood flow, is a severe complication of liver cirrhosis. The pathogenesis involves alteration of the liver vasculature due to fibrosis as well as increased production of vasoconstrictive mediators relative to endogenous vasodilators. Complications of PH include esophageal varices, gastric varices, portal hypertensive gastropathy, ascites, and hepatorenal syndrome. On endoscopy, the signs of portal hypertension include the presence of portal hypertensive gastropathy and/or esophageal/gastric varices. On Endoscopic Ultrasound (EUS), the liver parenchyma can be qualitatively and quantitatively assessed by imaging, “palpation,” as well as shear wave elastography. In addition, EUS can detect the presence of ascites, as well as intra and extra-mural dilated vessels that can be caused by PH. However, the most significant breakthrough for endoscopists is the ability to directly measure hepatic and portal vein pressures by means of EUS-guided portal pressure gradient (PPG) measurements. The endoscopic diagnosis of PH can be useful in determining the stage, progression, and prognosis of cirrhosis in individual patients.