Endoscopic ultrasound-guided portal pressure gradient measurement in managing portal hypertension

Portal hypertension (PH) is still a challenging clinical condition due to its silentmanifestations in the early stage and needs to be measured accurately for earlydetection. Hepatic vein pressure gradient measurement has been considered asthe gold standard measurement for PH; however, it needs special skill, experience, and high expertise. Recently, there has been an innovative development inusing endoscopic ultrasound (EUS) for the diagnosis and management of liverdiseases, including portal pressure measurement, which is commonly known asEUS-guided portal pressure gradient (EUS-PPG) mea-surement. EUS-PPGmeasurement can be performed concomitantly with EUS evaluation for deepesophageal varices, EUS-guided liver biopsy, and EUS-guided cyanoacrylateinjection. However, there are still major issues, such as different etiologies of liverdisease, procedural training, expertise, availability, and cost-effectiveness inseveral situations with regard to the standard management.