Endoscopic ultrasound-guided liver biopsy (EUS-LB) is a safe
alternative to percutaneous and transjugular routes with comparable diagnostic
yields. It is very suitable for the biopsy of both the hepatic lobe and can be
used to assess the portal pressure gradient (PPG) simultaneously.
The basic steps performed in the EUS-LB technique are:
- Localize avascular
path in the liver using gastric cardia in the left hepatic lobe or from D1 in
the right hepatic lobe.
- Puncture through
gastric or duodenal wall liver using a quick stroke.
- After entering the
liver parenchyma, turn on the suction by turning the stop-clock.
- Take around three actuations with the to-and-fro movement of
the needle.
- Needle travel: 3 cm course of the needle travels sufficient,
but a longer needle can be used if the condition permits.
- Turn off the suction before removing the needle from the
liver.
EUS-PPG is found to
have a good correlation with the hepatic venous pressure gradient.
Mathematically, it can be defined as “Portal pressure gradient (PPG) = Portal
venous pressure - Free hepatic venous pressure.”
Some important tips to remember while performing the EUS-PPG
technique are:
- Sedative agents are the Achilles heel of EUS-PPG as they can
affect the portal hemodynamic.
- Low doses of midazolam are preferred if needed.
- Entry site of the vessel should be surrounded by adequate liver
parenchyma for tamponade.
- When the needle is
passed into the hepatic vein, flush the needle with hep-saline before recording
the pressure reading.
- Take at least three pressure readings.
-
- Re-flush the needle
before taking the readings.
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