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
Affiliations
- Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany; Corresponding authors. Address: University Medical Center Freiburg, Department of Medicine II, Hugstetter Str. 55D- 79106 Freiburg, Germany; Tel.: +49 761/270-34010. (D. Bettinger), or Medical Clinic I for Gastroenterology, Hepatology, Diabetology & Nephrology, Robert-Koch-Straße 1, D- 84034 Landshut, Germany; Tel.: +49 0871 698 3717; (M. Dollinger).
- Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria, Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria, Department of Medicine III and Clinical Research Group Mechanisms in Portal Hypertension, Medical University of Vienna, Vienna, Austria
- Cristina Ripoll
- Internal Medicine IV, Department for Gastroenterology, Hepatology, Interdisciplinary Endoscopy and Infectious Diseases, Jena University Hospital, Friedrich-Schiller University, Jena 07747, Germany
- Christian Labenz
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Eugen Zizer
- Kreiskliniken Günzburg-Krumbach, Lindenallee 1, 89312 Günzburg, Germany
- Tony Bruns
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
- Andrea De Gottardi
- Luzerner Kantonsspital, Lucerne, Switzerland
- Johannes Emrich
- Medizinische Klinik II, St. Josefs-Hospital, Wiesbaden, Germany
- Cornelius Engelmann
- Medical Department, Division of Gastroenterology and Hepatology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Benjamin Maasoumy
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- Arnulf Ferlitsch
- Department of Internal Medicine I, St John of God Hospital, Vienna, Austria
- Valentin Fuhrmann
- Klinik für Innere Medizin, Heilig Geist Krankenhaus Köln, Graseggerstraße 105, 50737, Köln, Germany
- Jan Hinrichs
- St. Bernward Krankenhaus, Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, Hildesheim, Germany
- Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- Karoline Lackner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010, Graz, Austria
- Robert Matzberger
- Department of Medicine I (Gastroenterology, Hepatology, Diabetology & Nephrology), Klinikum Landshut, Landshut, Germany
- Carsten Meyer
- Department of Radiology, University Hospital, University Bonn, Bonn, Germany
- Behrang Mozayani
- Department of Pathology, Medical University of Vienna, Vienna, Austria
- Michael Praktiknjo
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology, Infectious Diseases, Universitätsklinikum Münster, Münster, Germany
- Philipp A. Reuken
- Internal Medicine IV, Department for Gastroenterology, Hepatology, Interdisciplinary Endoscopy and Infectious Diseases, Jena University Hospital, Friedrich-Schiller University, Jena 07747, Germany
- Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
- Alexander Zipprich
- Internal Medicine IV, Department for Gastroenterology, Hepatology, Interdisciplinary Endoscopy and Infectious Diseases, Jena University Hospital, Friedrich-Schiller University, Jena 07747, Germany
- Christian M. Lange
- Department of Internal Medicine II, LMU University Hospital Munich, Munich, Germany
- Roman Kloeckner
- Institute for Interventional Radiology, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
- Christoph Sarrazin
- Medizinische Klinik II, St. Josefs-Hospital, Wiesbaden, Germany
- Jonel Trebicka
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology, Infectious Diseases, Universitätsklinikum Münster, Münster, Germany
- Thomas Reiberger
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria, Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria, Department of Medicine III and Clinical Research Group Mechanisms in Portal Hypertension, Medical University of Vienna, Vienna, Austria
- Jaume Bosch
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Matthias M. Dollinger
- Department of Medicine I (Gastroenterology, Hepatology, Diabetology & Nephrology), Klinikum Landshut, Landshut, Germany; Corresponding authors. Address: University Medical Center Freiburg, Department of Medicine II, Hugstetter Str. 55D- 79106 Freiburg, Germany; Tel.: +49 761/270-34010. (D. Bettinger), or Medical Clinic I for Gastroenterology, Hepatology, Diabetology & Nephrology, Robert-Koch-Straße 1, D- 84034 Landshut, Germany; Tel.: +49 0871 698 3717; (M. Dollinger).
- DOI
- https://doi.org/10.1016/j.jhepr.2025.101437
- Journal volume & issue
-
Vol. 7,
no. 8
p. 101437
Abstract
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.
Keywords
- Cirrhosis
- porto-sinusoidal vascular disorder
- PSVD
- portal hypertension
- hepatic venous pressure gradient
- HVPG
