JHEP Reports (Aug 2025)

Transjugular diagnostic procedures in hepatology: Indications, techniques and interpretationKey points

  • Dominik Bettinger,
  • Annalisa Berzigotti,
  • Mattias Mandorfer,
  • Cristina Ripoll,
  • Christian Labenz,
  • Eugen Zizer,
  • Tony Bruns,
  • Andrea De Gottardi,
  • Johannes Emrich,
  • Cornelius Engelmann,
  • Benjamin Maasoumy,
  • Arnulf Ferlitsch,
  • Valentin Fuhrmann,
  • Jan Hinrichs,
  • Christian Jansen,
  • Karoline Lackner,
  • Robert Matzberger,
  • Carsten Meyer,
  • Behrang Mozayani,
  • Michael Praktiknjo,
  • Philipp A. Reuken,
  • Michael Schultheiss,
  • Alexander Zipprich,
  • Christian M. Lange,
  • Roman Kloeckner,
  • Christoph Sarrazin,
  • Jonel Trebicka,
  • Thomas Reiberger,
  • Jaume Bosch,
  • Matthias M. Dollinger

DOI
https://doi.org/10.1016/j.jhepr.2025.101437
Journal volume & issue
Vol. 7, no. 8
p. 101437

Abstract

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Summary: Measurement of the hepatic venous pressure gradient (HVPG) and transjugular liver biopsy have emerged as important tools in clinical hepatology. Measurement of HVPG is considered the gold standard for detecting clinically significant portal hypertension, with an HVPG of ≥10 mmHg being the key prognostic threshold in patients with compensated advanced chronic liver disease (cACLD; compensated cirrhosis). A transjugular liver biopsy can be obtained within the same procedure and may be preferred over percutaneous liver biopsy in patients with coagulopathy, ascites and/or significant obesity. Endoscopic ultrasound-guided procedures are currently under investigation and require standardisation. This article summarises critical technical aspects of HVPG measurements and transjugular liver biopsy and provides a detailed overview of their current role in the context of emerging non-invasive tests and endoscopic approaches.

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