title: Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics.
abstract: BACKGROUND
  Hepatic venous pressure gradient (HVPG) measurement is recommended for prognostic and therapeutic indications in centres with adequate resources and expertise. Our study aimed to evaluate the quality of HVPG measurements at our centre before and after introduction of a standardised protocol, and the clinical relevance of the HVPG to variceal bleeding in cirrhotics.
  
  
  METHODS
  HVPG measurements performed at Singapore General Hospital from 2005-2013 were retrospectively reviewed. Criteria for quality HVPG readings were triplicate readings, absence of negative pressure values and variability of ≤ 2 mmHg. The rate of variceal bleeding was compared in cirrhotics who achieved a HVPG response to pharmacotherapy (reduction of the HVPG to < 12 mmHg or by ≥ 20% of baseline) and those who did not.
  
  
  RESULTS
  126 HVPG measurements were performed in 105 patients (mean age 54.7 ± 11.4 years; 55.2% men). 80% had liver cirrhosis and 20% had non-cirrhotic portal hypertension (NCPH). The mean overall HVPG was 13.5 ± 7.2 mmHg, with a significant difference between the cirrhosis and NCPH groups (p < 0.001). The proportion of quality readings significantly improved after the protocol was introduced. HVPG response was achieved in 28 (33.3%, n = 84) cirrhotics. Nine had variceal bleeding over a median follow-up of 29 months. The rate of variceal bleeding was significantly lower in HVPG responders compared to nonresponders (p = 0.025).
  
  
  CONCLUSIONS
  The quality of HVPG measurements in our centre improved after the introduction of a standardised protocol. A HVPG response can prognosticate the risk of variceal bleeding in cirrhotics.
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Tze Tong
authors.initials: TT
authors.lastname: Tey
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Apoorva
authors.initials: A
authors.lastname: Gogna
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Farah Gillan
authors.initials: FG
authors.lastname: Irani
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Chow Wei
authors.initials: CW
authors.lastname: Too
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Hoau Gong Richard
authors.initials: HG
authors.lastname: Lo
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Bien Soo
authors.initials: BS
authors.lastname: Tan
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Kiang Hiong
authors.initials: KH
authors.lastname: Tay
authors.affiliation: Gleneagles Hospital, Singapore.
authors.forename: Hock Foong
authors.initials: HF
authors.lastname: Lui
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Pik Eu Jason
authors.initials: PE
authors.lastname: Chang
mesh_terms: D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Asia; Singapore; hepatic venous pressure gradient; quality; variceal bleeding