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Introduction EUS-PPG has emerged as an alternative approach to assess severity of portal hypertension (PH) with the advantage of estimating portal pressure directly over conventional Hepatic Venous Pressure Gradient (HVPG). We present our experience with EUS-PPG & EUS-guided liver biopsy as a single stage procedure. Surrogate markers of clinically significant PH (CSPH >10mmHg) were also explored.Methods Data was prospectively collected from November 2022 to December 2024 on patients undergoing EUS-PPG using Olympus GF-UCT260 EVIS LUCERA™ echoendoscopes, 25G EchoTip Insight™ PPG measurement system and biopsy using 19G FNB. Patient demographics, indication, sedation, platelet count, PH on imaging (PHI) or endoscopy (PHE), transient elastography (TE), hepatic vein (HVP) and portal vein (PVP) pressures, EUS-PPG, biopsy adequacy (>20mm and complete portal tracts (CPTs) >10), technical success, complications, 30-day mortality, and patient follow-up were analysed. Pearson’s r correlation, Fisher’s exact-test and logistic regression were used for the analysis (IBM SPSS v30).Results Of 54 patients (21 women) with suspected cirrhosis who underwent EUS-PPG, 48 had simultaneous liver biopsy; 49 procedures were performed under propofol sedation. The median age and BMI were 60 (32–72) years and 27 (15.7–43.5) Kg/M2 for men, 55 (22–79) years and 27.5 (20.5–61) Kg/M2 for women. The most common indication was pre-operative risk assessment (37%) – [ figure 1]. 26 patients had no evidence of PHI, 20 had low platelets count (LPLT<150 X 109/L [150 – 450]) and 22 had prior TE. EUS-PPG technical success was 100%. Mean HVP was 10.33mmHg (SEM 0.82), PVP 16.79mmHg (SEM 1.14) and EUS-PPG 6.85mmHg (SEM 0.95). 22 patients (41%) had PH, with 15 (28%) CSPH.EUS-PPG correlated with platelet count (r=-0.498, p<0.001) but not TE (r=0.323, p=0.142). In univariate regression analysis LPLT correlated with CSPH; (OR)=5.8 (p=0.008). LPLT with PHI (p=0.061) and PHE (p=0.058) showed a trend for correlation. In multivariate regression analysis only LPLT maintained a correlation with CSPH; (OR)=5.895 (p=0.029).47/48 (98%) biopsy specimens were adequate for pathological diagnosis: mean length 53mm (SD 20.5) and CPTs 29.4 (SD 14.5). 9/20 pre-operative patients proceeded to surgery whilst 11 were cancelled mostly unrelated to PH. 1 patient developed micro liver abscesses, 2 had uncomplicated abdominal pain and there was no 30-day mortality.Abstract O10 Figure 1Conclusion Multimodal hepatic assessment using EUS-PPG with liver biopsy is safe and feasible. Validation against long-term outcomes and the role of other surrogate markers within the clinical pathway requires further research.