EUS-guided Response Assessment to NSBB

Inclusion Criteria:

• Patients with a clinical and/or pathological diagnosis of compensated cirrhosis.

• Patients with suspicion of CSPH and thus indication for NSBB treatment.

• Patients not yet on NSBB therapy.

• Patients willing and able to undergo repeated HVPG and EUS-guided pressuremeasurements as per protocol.

Exclusion Criteria:

General criteria

• Patient is <18 or >80 years of age

• Patient is pregnant, breast-feeding or planning to become pregnant during the courseof the study

• Patient is unwilling or unable to sign the informed consent

• Patients in whom general anesthesia or endoscopic procedures are contraindicatedMedical criteria

• Patients with cirrhosis and HCC Portopulmonary hypertension Portal or splanchnicvenous thrombosis Prior TIPS Prior liver transplantation

• Non-cirrhotic portal hypertension or pre-sinusoidal liver disease

• Cholestatic liver disease with total bilirubin >3 mg/dl

• Previous total or partial splenectomy

• Known infection that is not controlled by medical intervention

• Patients with contraindications for non-selective beta-blocker therapy, includingbut not limited to the following baseline vital signs:

Systolic BP <100 mmHg HR <50 bpm

• Patients with reduced life expectancy described by an ASA score of 4 or 5

• INR >1.7 or platelet count <50.000 per mm3

• eGFR <50 ml/min/1.73m2 (CKD-EPI formula) Anatomical criteria

• Anatomical abnormalities that prevent access via EUS-guided puncture to the hepaticvein or intrahepatic portion of the portal vein, including anatomy that predisposesto difficult to reach puncture sites or an inadequate needle angle.

• Visualization of ascites interposing the puncture tract on EUS

• Diagnosis of portal vein thrombosis during EUS

• Evidence of active gastrointestinal bleeding during EUS