Comparison of balloon versus straight catheter for measurement of portal hypertension

Background & Aims: The hepatic venous pressure gradient (HVPG) is used as an estimation of portal pressure (PP) in the management of patients with cirrhosis. Two methods are available using either a straight (SC) or a balloon catheter (BC), but have never been compared head-to-head. The aim of the study was to compare the two methods regarding reproducibility and reliability. Methods: In 47 patients with cirrhosis, HVPG was assessed using both catheters in sequence. In another 29 patients, the wedged hepatic venous pressure (WHVP) determined either with SC or BC was correlated with a direct measurement of PP. Variation coefficient and intraclass correlation coefficient were calculated. Results: Variation coefficients for BC were 0.07 (HVPG), 0.02 (WHVP) and 0.06 (free hepatic venous pressure [FHVP]). Variation coefficients for SC were 0.17 (HVPG), 0.06 (WHVP) and 0.07 (FHVP), demonstrating a significantly wider variation of the HVPG and WHVP measurements (p<0.001). Comparison of WHVP with PP revealed an correlation coefficient of 0.72 (p=0.004) using BC and 0.58 (p=0.011) using SC. Conclusions: Measurements with the balloon catheter currently represent the most reliable and reproducible method to assess HVPG. The results are of particular clinical relevance, if repeated measurements are required for therapeutic adjustments.