Endoscopic Ultrasound Elastography in Pancreatic Diseases EUS-EG in Pancreatic Diseases

Elastography is a new ultrasound technique for tissue characterization, providing a noninvasive modality for the evaluation of tissue stiffness. Different pathologic processes such as cancerization and fibrosis alter tissue elasticity and therefore induce changes in elastographic appearance. The application of elastography to endoscopic ultrasound (EUS) technique allows a better characterization of lesions by the evaluation of tissue stiffness in sites only accessible from the gastrointestinal tract. In addition, the recent introduction of second-generation elastographic techniques (EUS-EG) allows an objective quantitative analysis of tissue strain. In the last years, EUS-EG has been increasingly used in the evaluation of several pancreatic diseases, including neoplasms, and inflammatory processes. Malignant pancreatic lesions are generally harder than adjacent pancreatic tissue, due to the presence of fibrosis and marked desmoplasia. In this setting, EUS-EG demonstrated high accuracy for the differential diagnosis of solid pancreatic tumors. Concerning parenchymal diseases, EUS-EG has been demonstrated to be a useful tool in the diagnosis of chronic pancreatitis and autoimmune pancreatitis. EUS-EG can provide an objective quantization of parenchymal stiffness, having a valuable role during the follow-up for monitoring possible disease progression and the need for medical treatment. We here aimed to review the main applications of EUS-EG in both focal and parenchymal pancreatic disease.