INCREASED RECEIPT OF CURATIVE INTENT THERAPY FOR LIVER CANCER AFTER EUS-GUIDED ASSESSMENT OF PORTAL HYPERTENSION

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: EUS-guided portal pressure gradient (EUS-PPG) measurement is increasingly utilized to evaluate for portal hypertension (PH) in patients with known or presumed cirrhosis. This technique allows for simultaneous EUS−guided liver biopsy (EUS-LB) and management of esophageal varices (EV) during one endoscopy. Despite the increasing adoption of EUS-PPG, limited data is available on the use of EUS-PPG measurement in patients with primary liver cancer (PLC). We aimed to determine if EUS-PPG measurements influenced the treatment options offered to patients with PLC. Methods: A retrospective chart review was performed of patients with PLC that underwent EUS-PPG measurements at our quaternary referral center between 2021 to 2023. Retrospective demographic, clinical, and procedure-specific information was extracted from the electronic medical record. Pretest anticipated treatment plans preceding EUS-PPG and post-procedure recommended treatments were documented for comparative analysis. Results: Between April 2021 and October 2023, 41 patients underwent EUS-PPG measurements and LB. 15 patients (36.5%) had a diagnosis of PLC and were majority male (73.3%), with a mean age of 43.6 years, and a mean MELD score of 11.2 (Table 1). 13 of the patients (86.6%) underwent EUS-PPG measurement with a median PPG of 5.3mmHg (IQR: 3.5-6.4). Obtaining the PPG was deferred in 2 cases as no safe window could be obtained. 14 (93.3%) of the PLC patients underwent EUS-LB during the same session. In one patient, EUS-LB was deferred as there was endoscopic evidence of PH (large EV) and EV band ligation was performed. The mean procedure duration was 60 ± 19.7 minutes. No intra-procedural AEs were reported. Of the 15 patients with PLC referred for EUS-PPG, 13 (86.6%) had pre-endoscopy cross-sectional imaging concerning for cirrhosis. However, based on the EUS-LB, ultimately 6 (42.8%) of the patients had biopsy-proven cirrhosis. The biopsy sample was adequate in 13/14 (93%) patients. Only 7 of the 13 patients with imaging findings concerning for cirrhosis had a PPG ≥ 5 mmHg. In this series, data collected from EUS-PPG and EUS-LB changed management recommendations in 10/15 patients, importantly offering some patients curative intent therapy for PLC (Table 2). Conclusion: This study highlights the utility of further classification of the presence or absence of portal hypertension through direct pressure measurement. In this cohort of patients with PLC with baseline testing deeming them unresectable, curative therapy was offered to an increased number of patients on the basis of EUS-PPG measurements and endoscopic 19-gauge liver biopsies. In compensated patients with Child-Pugh class A cirrhosis where resectability is in question, one should consider further inquiry into the degree of portal hypertension understanding our present limitations through biochemical and imaging testing.

Volume

99

Issue

6

First Page

AB807

Last Page

AB808

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