# Same Session Validation of a Custom‐Built 22G With the Commercial 25G System for EUS‐Guided Portal Pressure Gradient Measurement

## TL;DR

Researchers validated a custom 22G system for measuring portal pressure during endoscopic ultrasound, showing it works as well as the commercial 25G system but with added benefits like real-time pressure tracking and lower cost.

## Contribution

First same-session validation of a custom 22G EUS-PPG system against the commercial 25G system, demonstrating equivalent performance with improved flexibility and cost-efficiency.

## Key findings

- PPG values from the 22G and 25G systems showed excellent correlation (r = 0.901).
- The 22G system correctly identified 96.2% of cases with clinically significant portal hypertension.
- Portal and hepatic vein pressures also correlated significantly between the two systems.

## Abstract

Endoscopic ultrasound‐guided portal pressure gradient (EUS‐PPG) measurement is a promising alternative to hepatic venous pressure gradient (HVPG) assessment, especially in settings where HVPG is unavailable or limited. The commercial 25‐gauge (25G) system showed good correlation with the hepatic venous pressure gradient (HVPG). However, the 25G has drawbacks due to its small caliber and the proprietary pressure transducer. The aim of this study was to validate a custom‐built 22G conventional intravascular pressure transducer system (22G EUS‐PPG).

In this prospective cohort study, 26 patients underwent EUS‐PPG measurement using both systems during the same session. The primary outcome was the correlation of PPG values. Secondary outcomes included the correlation and variability of portal vein pressure (PVP) and hepatic vein pressure (HVP) measured by both systems.

PPG values showed excellent correlation of both systems (r = 0.901, p < 0.001). 25G EUS‐PPG correctly identified clinically significant portal hypertension (CSPH, defined as PPG ≥ 10mmHg) in 25 of 26 (96.2%) cases. Portal vein and hepatic vein pressures also correlated significantly (r = 0.776 and r = 0.673, respectively) between both systems. Variability within both systems was very low to low.

EUS‐PPG measurements obtained using the commercial 25G and custom‐built 22G EUS‐PPG systems were validated. The custom‐built 22G system excels due to pressure‐tracing based quality control, availability and cost‐efficiency.

Summarize the established knowledge on this subject◦EUS‐guided portal pressure gradient (EUS‐PPG) measurement using a commercial 25G system is a minimally invasive alternative to hepatic venous pressure gradient (HVPG) for evaluating portal hypertension.◦The commercial 25G device lacks real‐time pressure tracing due to a propietary transducer system.◦Limited availability and reimbursement of this device restrict the clinical adoption of EUS‐PPG in many healthcare systems.◦No adaptable alternative has previously been validated against the commercial system in a same‐session setting.What are the significant and/or new findings of this study?◦This is the first prospective same‐session validation of a custom‐built 22G EUS‐PPG system against a commercial 25G device under identical conditions.◦The 22G system showed excellent correlation with the commercial device and equivalent diagnostic performance for clinically significant portal hypertension.◦Integration with a standard intravascular pressure transducer enables real‐time pressure tracing and broader technical flexibility.◦The system provides a reliable, safe and cost‐efficient alternative that can expand access to EUS‐PPG across diverse healthcare environments.

Summarize the established knowledge on this subject

EUS‐guided portal pressure gradient (EUS‐PPG) measurement using a commercial 25G system is a minimally invasive alternative to hepatic venous pressure gradient (HVPG) for evaluating portal hypertension.

The commercial 25G device lacks real‐time pressure tracing due to a propietary transducer system.

Limited availability and reimbursement of this device restrict the clinical adoption of EUS‐PPG in many healthcare systems.

No adaptable alternative has previously been validated against the commercial system in a same‐session setting.

What are the significant and/or new findings of this study?

This is the first prospective same‐session validation of a custom‐built 22G EUS‐PPG system against a commercial 25G device under identical conditions.

The 22G system showed excellent correlation with the commercial device and equivalent diagnostic performance for clinically significant portal hypertension.

Integration with a standard intravascular pressure transducer enables real‐time pressure tracing and broader technical flexibility.

The system provides a reliable, safe and cost‐efficient alternative that can expand access to EUS‐PPG across diverse healthcare environments.