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Background and objective: 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 against hepatic venous pressure gradient (HVPG). However, the 25G has drawbacks due to its small calibre and the proprietary pressure transducer. The aim of this study is to validate a custom-built 22G conventional intravascular pressure transducer system (22G EUS-PPG).

Method: In this prospective 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.

Result: 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 ≥ 10 mmHg) 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.

Summary: EUS-PPG measurements obtained with the commercial 25G and custom-built 22G EUS-PPG systems are validated. The custom-built 22G system excels due to pressure-tracing quality control, availability and cost-efficiency.