Clinical Endoscopy

Reviews

Endoscopic ultrasound-guided strain and shear wave elastography for pancreatic and liver diseases: Raymond S.Y. Tang, Ting Ting Chan; Received August 2, 2025 Accepted August 13, 2025 Published online January 5, 2026; DOI: https://doi.org/10.5946/ce.2025.258 [Epub ahead of print]

Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.

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EFFECTIVENESS OF SHEAR WAVE ELASTOGRAPHY FOR PREOPERATIVE ASSESSMENT OF PANCREATIC FIBROSIS IN CHRONIC PANCREATITIS
V. O. Shaprynskyi, Yu. A. Punko
Kharkiv Surgical School.2026; (1): 40. CrossRef

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Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions: Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2024;57(2):164-174. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.074

Abstract PDF PubReader ePub

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

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Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Diagnosing Gastric Subepithelial Tumors
Moon Won Lee, Dong Chan Joo, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon
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AI-Driven Breast Cancer Diagnosis: A Systematic Review of Imaging Modalities, Deep Learning, and Explainability
Margo Sabry, Hossam Magdy Balaha, Khadiga M. Ali, Ali Mahmoud, Dibson Gondim, Mohammed Ghazal, Tayseer Hassan A. Soliman, Ayman El-Baz
Cancers.2026; 18(8): 1305. CrossRef
The evolving landscape of EUS utilization in the management of pancreatic cystic neoplasms
Daniel Marino, Tamas A. Gonda
Pancreatology.2025; 25(3): 289. CrossRef
The impact of the novel EUS scope and ultrasonographic system for diagnosis and therapy in patients with pancreatobiliary diseases (videos)
Hiroyuki Kojima, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Kenjiro Yamamoto, Yukitoshi Matsunami, Hirohito Minami
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Peter Slodička, Vít Navrátil, Vincent Dansou Zoundjiekpon, Lumír Kunovský
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Advances in endoscopic ultrasound-guided shear wave elastography: A comprehensive review of its clinical applications
Mattia Paratore, Sara Miliani, Giulia D’Acunzo, Nicholas Viceconti, Silvia Andaloro, Giuseppe Cerniglia, Fabrizio Mancuso, Elena Melita, Gianenrico Rizzatti, Antonio Gasbarrini, Laura Riccardi, Matteo Garcovich
World Journal of Gastroenterology.2025;[Epub] CrossRef
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Giorgio Esposto, Giuseppe Massimiani, Linda Galasso, Paolo Santini, Raffaele Borriello, Irene Mignini, Maria Elena Ainora, Alberto Nicoletti, Lorenzo Zileri Dal Verme, Antonio Gasbarrini, Sergio Alfieri, Giuseppe Quero, Maria Assunta Zocco
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Marzia Varanese, Marco Spadaccini, Antonio Facciorusso, Gianluca Franchellucci, Matteo Colombo, Marta Andreozzi, Daryl Ramai, Davide Massimi, Roberto De Sire, Ludovico Alfarone, Antonio Capogreco, Roberta Maselli, Cesare Hassan, Alessandro Fugazza, Alessa
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Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
Medicina.2024; 60(12): 2021. CrossRef

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Original Article

Defining the optimal technique for endoscopic ultrasound shear wave elastography: a combined benchtop and animal model study with comparison to transabdominal shear wave elastography: Thomas J. Wang, Marvin Ryou; Clin Endosc 2023;56(2):229-238. Published online February 28, 2023; DOI: https://doi.org/10.5946/ce.2022.135

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Shear wave elastography (SWE) is used for liver fibrosis staging based on stiffness measurements. It can be performed using endoscopic ultrasound (EUS) or a transabdominal approach. Transabdominal accuracy can be limited in patients with obesity because of the thick abdomen. Theoretically, EUS-SWE overcomes this limitation by internally assessing the liver. We aimed to define the optimal technique for EUS-SWE for future research and clinical use and compare its accuracy with that of transabdominal SWE.
Methods
Benchtop study: A standardized phantom model was used. The compared variables included the region of interest (ROI) size, depth, and orientation and transducer pressure. Porcine study: Phantom models with varying stiffness values were surgically implanted between the hepatic lobes.
Results
For EUS-SWE, a larger ROI size of 1.5 cm and a smaller ROI depth of 1 cm demonstrated a significantly higher accuracy. For transabdominal SWE, the ROI size was nonadjustable, and the optimal ROI depth ranged from 2 to 4 cm. The transducer pressure and ROI orientation did not significantly affect the accuracy. There were no significant differences in the accuracy between transabdominal SWE and EUS-SWE in the animal model. The variability among the operators was more pronounced for the higher stiffness values. Small lesion measurements were accurate only when the ROI was entirely situated within the lesion.
Conclusions
We defined the optimal viewing windows for EUS-SWE and transabdominal SWE. The accuracy was comparable in the non-obese porcine model. EUS-SWE may have a higher utility for evaluating small lesions than transabdominal SWE.

Citations

Citations to this article as recorded by

Endoscopic Ultrasound-based Shear Wave Elastography for Detection of Advanced Liver Disease
Jad AbiMansour, Jerry Yung-Lun Chin, Jyotroop Kaur, Eric J. Vargas, Barham K. Abu Dayyeh, Ryan Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Sudhakar Venkatesh, Vinay Chandrasekhara
Journal of Clinical Gastroenterology.2025; 59(3): 256. CrossRef
EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction–associated steatotic liver disease: a pilot study (with video)
Thomas J. Wang, Pichamol Jirapinyo, Raj Shah, Kimberly Schuster, David J. Papke, Christopher C. Thompson, Laura Doyon, David B. Lautz, Marvin Ryou
Gastrointestinal Endoscopy.2025; 101(2): 456. CrossRef
Reproducibility of EUS-guided shear wave elastography for assessment of hepatic fibrosis: a prospective pilot cohort study
David L. Diehl, Vikas Sangwan, Sandeep Khurana, Harshit S. Khara, Jianying Zhang, Bradley D. Confer
Gastrointestinal Endoscopy.2025; 101(3): 659. CrossRef
Endoscopic Ultrasound–Guided Portosystemic Pressure Gradient Correlates With Clinical Parameters and Liver Histology
Jennifer M. Kolb, Marc Monachese, Raymond A. Rubin, Thomas J. Wang, Alyssa Choi, Ahmad N. Bazarbashi, Bhaumik Brahmbhatt, Ali Zakaria, Pedro Cortes, Varun Kesar, William F. Abel, Wen-Pin Chen, Christine McLaren, Amirali Tavangar, Amit G. Singal, Pushpak T
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Endohepatology in the Management of Liver Diseases
Thomas J. Wang, Ajaypal Singh
Seminars in Liver Disease.2025; 45(04): 439. CrossRef
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Nikhil Sonthalia, Awanish Tewari, Akash Roy, Uday C. Ghoshal, Mahesh K. Goenka
Journal of Digestive Endoscopy.2025; 16(04): 220. CrossRef
Assessment of Intra-Individual Variability and Reproducibility in Pancreatic EUS-Guided Elastography
Bogdan Miutescu, Renata Bende, Felix Bende, Adrian Burdan, Eyad Gadour, Ana Maria Ghiuchici, Mohammed Alomar, Calin Burciu, Mohammed Saad AlQahtani, Roxana Sirli, Alina Popescu, Iulia Ratiu
Diagnostics.2025; 15(20): 2601. CrossRef
Advances in endoscopic ultrasound-guided shear wave elastography: A comprehensive review of its clinical applications
Mattia Paratore, Sara Miliani, Giulia D’Acunzo, Nicholas Viceconti, Silvia Andaloro, Giuseppe Cerniglia, Fabrizio Mancuso, Elena Melita, Gianenrico Rizzatti, Antonio Gasbarrini, Laura Riccardi, Matteo Garcovich
World Journal of Gastroenterology.2025;[Epub] CrossRef
Response
Divyanshoo R. Kohli, Mohammad Shadab Siddiqui
Gastrointestinal Endoscopy.2024; 100(1): 161. CrossRef
Advancements and challenges in gastrointestinal imaging
Eun Jeong Gong, Chang Seok Bang
World Journal of Clinical Cases.2024; 12(33): 6591. CrossRef
The Role of Endoscopic Ultrasound-Guided Shear Wave Elastography in Pancreatic Diseases
Yazan Abboud, Srinivas Gaddam
Diagnostics.2024; 14(20): 2329. CrossRef
EUS-based shear wave elastography of the spleen for detection of clinically significant portal hypertension
Jad P. AbiMansour, Jerry Yung-Lun Chin, Eric J. Vargas, Jyotroop Kaur, Barham K. Abu Dayyeh, Ryan J. Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Vinay Chandrasekhara
iGIE.2024; 3(4): 507. CrossRef
Standardization of endoscopic ultrasound shear wave elastography
Julio Iglesias-García, J. Enrique Domínguez-Muñoz
Clinical Endoscopy.2023; 56(2): 185. CrossRef

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Focused review series

Elastography of the Pancreas, Current View: Christoph F. Dietrich, Michael Hocke; Clin Endosc 2019;52(6):533-540. Published online July 17, 2019; DOI: https://doi.org/10.5946/ce.2018.156

Abstract PDF PubReader ePub

Ultrasound elastography (USE) of the pancreas allows pancreatic tissue stiffness assessment by virtual palpation. Two main types of USE are used. For the pancreas strain elastography applying by endoscopic ultrasound has been established for the characterisation of small solid pancreatic lesions (SPL). In larger SPL >30 mm the results are less convincing mainly due to the heterogenicity of the lesions but also by concomitant changes of the surrounding pancreatic parenchyma. The current role of shear wave elastography has to be determined. This article reviews the current use of elastography of the pancreas.

Citations

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