severe coagulopathy (INR \>2.0), thrombocytopenia (\<50,000/µL)

large-volume ascites

gastric varices precluding safe vascular puncture

known hepatic vein thrombosis or Budd-Chiari syndrome

altered IVC anatomy such as patients after liver transplantation with piggy-back anastomosis

contraindication to upper gastrointestinal endoscopy or sedation

pregnancy

Inferior Vena Cava Pressure as Alternative to Hepatic Venous Pressure for EUS-guided Portal Pressure Gradient Measurement