ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology (On-Demand) | July 2023-7-13-23 Endoscopy Live Case Demonstration 4

Video Transcription

Video Summary

In this video, Dr. Kenneth Chang from UC Irvine demonstrates an EUS-guided portal pressure gradient measurement, shear wave, and liver biopsy. The case involves a 75-year-old female with asymptomatic jaundice and a history of fatty liver, obesity, Crohn's disease, and hypertension. The patient's clinical data includes elevated bilirubin, mildly elevated alkaline phosphatase, normal autoimmune and viral hepatitis workup, low platelets, and an enlarged liver and spleen. She underwent outpatient fibro scan and MRI, which showed F4 fibrosis and no primary sclerosing cholangitis. To assess the patient's fibrosis staging and portal pressures, Dr. Chang performs shear wave elastography, measuring stiffness in the liver and spleen. He finds elevated stiffness in both. Next, he performs a portal pressure measurement using a 25-gauge needle. The hepatic vein pressure is measured at 7 millimeters of mercury, and the left portal vein pressure is measured at 16 millimeters of mercury, resulting in a portal pressure gradient of 9 millimeters of mercury. This confirms the presence of portal hypertension. Dr. Chang discusses the significance of the diagnosis and the potential for reversibility with aggressive metabolic disease management. The next step is liver biopsy to determine the etiology of the patient's liver disease. The video demonstrates the placement of the needle in the left hepatic vein for biopsy. Given the elevated portal pressure gradient, further investigation and treatment will be required. The video is part of a presentation by Dr. Chang and his team at UC Irvine. No external credits were mentioned.

Asset Subtitle

EUS-guided PPGmeasurement/shear wave/liver biopsy
Endoscopist: Dr. Kenneth Chang(University of California Irvine)

Keywords

EUS-guided portal pressure gradient measurement

shear wave elastography

liver biopsy

portal hypertension

fibrosis staging

metabolic disease management

UC Irvine