Innovations in endoscopic ultrasound for portal hypertension and its role in managing complications in clinical practice: Lessons learned from a tertiary referral public hospital

Portal hypertension (PH) poses significant challenges. This paper presents an innovative study on the utilization of endoscopic ultrasound (EUS) for both the diagnosis and management of PH. Conducted at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, this retrospective case series included patients diagnosed with PH through clinical examination, imaging evaluation, and esophagogastroduodenoscopy. Exclusion criteria comprised a history of reduced blood consumption within the last 5 days, hepatocellular carcinoma, massive ascites, or elevated international normalized ratio (>1.4). EUS-guided portal pressure gradient (PPG) measurements were performed using an innovative standard manometer. The study involved 15 patients, with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari syndrome. Among them, nine patients experienced bleeding due to gastroesophageal varices. Small and large esophageal varices were identified in four and eight patients, respectively. Gastroesophageal varices type 1 were observed in two patients, and type 2 in four patients. Isolated gastric fundal varices type 1 were present in one patient. Based on EUS-PPG measurements, 14 patients exhibited clinically significant portal hypertension. Seven patients underwent endoscopic band ligation and three underwent EUS-guided cyanoacrylate injection during the same session as the EUS-PPG measurement procedure. Notably, no adverse events, such as abdominal pain, perforation, or bleeding were observed during or after the procedure. EUS emerges as a promising and accurate tool for both diagnosis and management.