Ultrasound‐Guided Fine‐Needle vs. Transjugular Portal Pressure Measurements in Non‐Viral, Non‐Alcoholic Cirrhosis

ABSTRACT Background and Aims Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension in patients with viral‐ and alcohol‐related cirrhosis, but its accuracy is limited in other aetiologies. This study aimed to evaluate the correlation of portal venous pressure measurements in patients with non‐alcoholic, non‐viral‐related decompensated cirrhosis, using fine‐needle puncture (FN‐PVP), direct portal vein catheterisation (D‐PVP) and wedged hepatic vein balloon occlusion (WHVP). Methods This study retrospectively included patients from the author's centre who simultaneously underwent FN‐PVP, HVPG and transjugular intrahepatic portosystemic shunt (TIPS) placement for variceal bleeding or refractory ascites. The Spearman correlation coefficient (r), linear regression coefficient (R 2 ), intraclass correlation coefficient (ICC) and the Bland–Altman method were used to assess the correlation and consistency between the pressure measurements obtained by the different methods. Results Seventy‐one patients were included, all undergoing FN‐PVP measurements without procedure‐related complications. The correlation and consistency between WHVP and D‐PVP were moderate ( r = 0.487, R 2 = 0.25), while FN‐PVP demonstrated excellent correlation and consistency with D‐PVP ( r = 0.945, R 2 = 0.914). Similar patterns were observed when comparing HVPG and direct portal pressure gradient (D‐PPG), fine‐needle portal pressure gradient (FN‐PPG) and D‐PPG (r: 0.558 vs. 0.918; R 2 : 0.302 vs. 0.87). In patients without intrahepatic venovenous shunts (IHVS), the correlation and consistency between WHVP and D‐PVP showed slight improvement ( r = 0.609, ICCa = 0.523, ICCc = 0.620). Using D‐PPG as the benchmark, FN‐PPG demonstrated excellent classification accuracy, significantly outperforming HVPG. Conclusion In patients with non‐alcoholic, non‐viral‐related PHT, HVPG may underestimate the true PPG, regardless of the presence of IHVS. In contrast, FN‐PVP can safely and accurately reflect portal pressure and serves as an effective alternative for direct portal pressure measurement.