Just like the hypertension that people develop when their blood pressure increases, the increase of blood pressure in the main vein that supplies blood to the liver, called the portal vein, is also a dangerous situation. This condition, called portal hypertension, is the main side effect of liver cirrhosis, and the development of complications like ascites, hepatic encephalopathy and variceal hemorrhage are dependent on the severity of this hypertension. Recording portal hypertension is therefore crucial when studying the effect of drugs used to treat cirrhosis and for predicting patient prognosis.
Credit: Portal Hypertension & Cirrhosis
Just like the hypertension that people develop when their blood pressure increases, the increase of blood pressure in the main vein that supplies blood to the liver, called the portal vein, is also a dangerous situation. This condition, called portal hypertension, is the main side effect of liver cirrhosis, and the development of complications like ascites, hepatic encephalopathy and variceal hemorrhage are dependent on the severity of this hypertension. Recording portal hypertension is therefore crucial when studying the effect of drugs used to treat cirrhosis and for predicting patient prognosis.
Hepatic venous pressure gradient (HVPG) represents the difference between pressures in the portal vein and the intra-abdominal portion of inferior vena cava, another major vein, and is the standard method used to assess portal hypertension. However, unlike overall blood pressure, this method is invasive, because the vein is located deep in the body. Therefore, it isn’t performed commonly, and so, patients who are recommended for this method might not know much about it.
Patient tolerance and acceptance are important if medical techniques are to be used more widely. But the tolerance and acceptance of patients with liver cirrhosis hasn’t been studied. So, a team of researchers led by Dr. Xiaolong Qi of The First Hospital of Lanzhou University, China addressed this gap in their latest study published in Portal Hypertension & Cirrhosis. The team conducted a prospective international study among 271 patients with liver cirrhosis. Data related to tolerance and acceptance was assessed by using questionnaires.
They found that over 80% of patients had no or mild discomfort either during the procedure or after it. Almost 50% of patients had little to no understanding of the value of HVPG measurement and around 39% of patients regarded HVPG measurements of being little to no help. Only 15% of patients reported that they would definitely undergo the procedure again with the rest of the patients weren’t too sure about it; 63% of patients found the cost of the procedure to be acceptable.
So, what do these results signify? Dr. Qi states “The results of our study indicate that HVPG was found to be tolerated well in patients with cirrhosis. But we expected a much higher rate of acceptance among patients. Half the patients did not understand the value of the procedure, suggesting that the communication between doctors and patients was insufficient. If patients don’t have the right information and knowledge about a procedure, they’re less likely to choose it. Clinicians should make it a priority to properly educate and guide patients in understanding the value of HVPG measurements.”
This study highlights the need for patient education and awareness about this procedure in order to improve its overall acceptance. This is important, because the use of this procedure can help in achieving early diagnosis and improving patient outcomes in patients with cirrhosis. “We hope that our study will pave the way for this procedure to be widely accepted by the general public and medical community,” concludes Dr. Qi.
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Reference
DOI: https://doi.org/10.1002/poh2.4
Authors:
Junhui Sun, He Zhao, Haijun Zhang, Lei Li, Necati Örmeci, Ziniu Yu, Xun Li, Shuangxi Li, Xujun Yang, Huaping Wei, Xiaoliang Zhu, Zhengcong Zhang, Yajin Wang, Zhongwei Zhao, Jianting Mao, Qiaohong Wu, Xiaole Sun, Huiling Xiang, Kefeng Jia, Chao Yang, Wei Wu, Xiuqing Lin, Haixin Yao, Changzeng Zuo, Jitao Wang, Bo Zhang, Chunqing Zhang, Xiaoling Wu, Guangchuan Wang, Shengjuan Yao, Ruihang Wang, Li Zhou, Hui Huan, Qingli Tu, Xue Pu, Feng Zhang, Qin Yin, Linpeng Zhang, Ying Guo, Jian Wang, Kohei Kotani, Sawako Uchida-Kobayashi, Norifumi Kawada, He Zhu, Li Noricum, Wei Wang, Guo Zhang, Lei Yu, Xudong Cui, Qingliang Zhu, Hailong Zhang, Xiaoli Hu, Rafael Oliveira Ximenes, Adriano Gonçalves de Araújo, Giulliano Gardenghi, Yubao Zheng, Zebin Wu, Mingsheng Huang, Xiaoyong Chen, Jun Wu, Feng Xie, Yang Bo, Shengjuan Hu, Linke Ma, Xiao Li , Xiaolong Qi.
Affiliations
1. CHESS study group, Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Zhejiang Provincial Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, Zhejiang 310003, China.
2. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
3. CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
4. Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
5. Interventional Radiology Department, The First Hospital of Lanzhou University, Lanzhou, Gansu 73000, China
6. Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
7. Department of Internal Medicine, Istanbul Health and Technology University Medical School, Istanbul, Turkey.
8. Department of General surgery, The First Hospital of Lanzhou University, Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, Gansu 730000, China.
9. Interventional Radiology Department, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
10. Nursing Department, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
11. Department of General Surgery, Donggang Branch, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
12. The Diagnosis and Treatment Center of Endoscopy and Interventional Radiology, Donggang Branch, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
13. Department of Interventional Radiology, Lishui Central Hospital, Lishui, Zhejiang 323020, China.
14. Department of Hepatology and Gastroenterology of The Third Central Hospital of Tianjin, Tianjin 300250, China.
15. Department of Radiology of The Third Central Hospital of Tianjin, Tianjin 300250, China.
16. Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China.
17. Department of Hepatobiliary Surgery, Xingtai People’s Hospital, Xingtai 054001, China.
18. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
19. Department of Radiology, Tianjin Second People’s Hospital, Tianjin 300192, China.
20. Department of Gastroenterology and Hepatology, Tianjin Second People’s Hospital, Tianjin 300192, China.
21. Department of Gastroenterology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan 610041, China.
22. The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China.
23. Department of Interventional Radiology, The Third People’s Hospital of Taiyuan, Taiyuan, Shanxi 030009, China
24. Department of Hepatology, The Third People’s Hospital of Taiyuan, Taiyuan, Shanxi 030009, China.
25. Department of Hepatology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
26. Department of Interventional Radiology, The Sixth Hospital of Shenyang, Shenyang, Liaoning, 110006, China.
27. Department of Gastroenterology, The People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530016, China.
28. Department of Interventional Radiology, The People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530016, China.
29. Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646099, China.
30. Gastroenterology Department, University of Sao Paulo. Sao Paulo, Brazil.
31. Interventional Cardiology Department, Hospital ENCORE, Aparecida de Goiânia, Brazil.
32. Department of Scientific Coordination, Hospital ENCORE, Aparecida de Goiânia, Brazil.
33. Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
34. Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong 510630, China.
35. Department of Hepatology, The Second People‘s Hospital of Lanzhou City, Lanzhou, Gansu 730000, China.
36. Department of Radiology, The Second People‘s Hospital of Lanzhou City, Lanzhou, Gansu 730000, China.
37. Department of Ultrasonography, The Second People‘s Hospital of Lanzhou City, Lanzhou, Gansu 730000, China.
38. Department of Gastroenterology, The People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, China.
About Professor Xiaolong Qi
Dr. Xiaolong Qi is the founder and chair of Chinese Portal Hypertension Alliance (CHESS), a group involving over 500 hospitals in China with ties to numerous hepatologists and gastroenterologists all over the world. He is also the chair of Committee of portal hypertension, China association for promotion of health science and technology. His research is focused on management of portal hypertension and cirrhosis. He has published more than 130 peer-reviewed articles with a total citation number of 4000.
DOI
10.1002/poh2.4
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
Article Title
Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis (CHESS1904): an international multicenter study
Article Publication Date
31-May-2022
COI Statement
Author Xiaolong Qi is the Editor-in-Chief of Portal Hypertension & Cirrhosis. He is therefore excluded from the peer-review process and all editorial decisions related to the publication of this manuscript. The authors declared that they have no other conflicts of interest with reference to this manuscript.