Portal Pressure Measurements: Locations, Implications, and State of the Art

Portal hypertension defined as pressure within the portal venous system is an important event in the evolution of cirrhosis. With the development of clinically significant portal hypertension, there is increased risk of developing gastroesophageal varices and hepatic decompensation. Endoscopic evaluation of esophageal and gastric varices and hepatic venous pressure gradient (HVPG) measurement are gold standard methods for evaluating portal hypertension. Additionally, measurement of HVPG is important in prognostication and assessing efficacy of pharmacotherapy. New state-of-the-art noninvasive techniques are available for diagnosis and assessment of portal hypertension severity. While some of these are validated for larger clinical application, others are still experimental. In this review, we have discussed invasive and noninvasive portal hypertension measurement techniques.