Endoscopic Ultrasound-Guided Versus Transjugular Portal Pressure Measurements: Systematic Review and Meta-Analysis

Rintaro Hashimoto; Tomohiro Tanaka; Kenneth J Chang

doi:10.1007/s10620-026-10042-4

Endoscopic Ultrasound-Guided Versus Transjugular Portal Pressure Measurements: Systematic Review and Meta-Analysis

Dig Dis Sci. 2026 Jun 5. doi: 10.1007/s10620-026-10042-4. Online ahead of print.

Authors

Rintaro Hashimoto¹, Tomohiro Tanaka², Kenneth J Chang³

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA, 52242, USA. rintaro-hashimoto@uiowa.edu.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Health Care, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
³ Division of Gastroenterology and Hepatology, Digestive Health Institute, Hoag Memorial Hospital Presbyterian, Hoag Health, 500 Superior Avenue, Newport Beach, CA, 92663, USA.

PMID: 42249245
DOI: 10.1007/s10620-026-10042-4

Abstract

Purpose: Published reviews of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) have emphasized feasibility and safety. We performed a systematic review and meta-analysis specifically to evaluate how closely EUS-based portal pressure measurements track invasive comparator measurements in prospective paired studies and to summarize agreement, technical success, and adverse events.

Methods: We searched major databases through January 2026 for prospective cohorts reporting same-patient EUS-based portal pressure measurement and invasive hemodynamic measurements. Correlations were pooled with random-effects models and analyzed separately for studies comparing EUS-PPG with hepatic venous pressure gradient (HVPG) and studies comparing EUS-based portal measurements with direct portal venous pressure. Agreement and threshold discordance were summarized descriptively.

Results: Six prospective cohorts (127 attempted procedures) were included. In studies using HVPG as the comparator, the pooled correlation was 0.82 (95% CI, 0.72-0.89; I² = 0%). In studies comparing EUS-based portal measurements with direct portal venous pressure, the pooled correlation was 0.86 (95% CI, 0.72-0.93; I² = 16.9%). Technical success was 95.3%. EUS-PPG-attributed adverse events occurred in 2.4% of procedures, with no procedure-related deaths. Agreement data were limited. Reported limits of agreement were wide (approximately - 6 to + 7 mmHg), and discrepancies of 5 mmHg or greater occurred in 4 of 30 paired measurements.

Conclusions: EUS-based portal pressure measurement is feasible and shows a strong association with invasive hemodynamic comparators, but the evidence base remains small (six cohorts, 127 attempted procedures). Further study will be necessary to establish patient-level agreement, procedural reproducibility, EUS-specific clinically significant portal hypertension thresholds, and whether HVPG-based decision thresholds can be transferred to EUS-derived measurements.

Keywords: Endosonography; Meta-analysis as topic; Portal hypertension; Portal pressure; Systematic reviews as topic.