Skip to main content
SpringerLink
Log in

Endoscopic Ultrasound Elastography in Pancreatic Diseases

EUS-EG in Pancreatic Diseases

  • Chapter
  • First Online:
Elastography of the Liver and Beyond

  • 335 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Iglesias-Garcia J, et al. Endoscopic ultrasound elastography. Endosc Ultrasound. 2012;1(1):8–16.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mondal U, et al. Endoscopic ultrasound elastography: current clinical use in pancreas. Pancreas. 2016;45(7):929–33.

    Article  PubMed  Google Scholar 

  3. Iglesias-Garcia J, et al. Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses. Gastroenterology. 2010;139(4):1172–80.

    Article  PubMed  Google Scholar 

  4. Ohno E, et al. Diagnostic performance of endoscopic ultrasonography-guided elastography for solid pancreatic lesions: shear-wave measurements versus strain elastography with histogram analysis. Dig Endosc. 2020;33:629.

    Article  PubMed  Google Scholar 

  5. Hirooka Y, et al. JSUM ultrasound elastography practice guidelines: pancreas. J Med Ultrason (2001). 2015;42(2):151–74.

    Article  Google Scholar 

  6. Itoh Y, et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol. 2014;49(7):1183–92.

    Article  PubMed  Google Scholar 

  7. Kuwahara T, et al. Quantitative diagnosis of chronic pancreatitis using EUS elastography. J Gastroenterol. 2017;52(7):868–74.

    Article  PubMed  Google Scholar 

  8. Ohno E, et al. Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study. J Med Ultrason (2001). 2019;46(4):425–33.

    Article  Google Scholar 

  9. Ignee A, et al. Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study. Endoscopy. 2018;50(11):1071–9.

    Article  PubMed  Google Scholar 

  10. Zhang B, et al. Endoscopic ultrasound elastography in the diagnosis of pancreatic masses: a meta-analysis. Pancreatology. 2018;18(7):833–40.

    Article  PubMed  Google Scholar 

  11. Huang C, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Pei Q, et al. Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: a meta-analysis. Pancreatology. 2012;12(5):402–8.

    Article  PubMed  Google Scholar 

  13. Li X, et al. Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: a meta-analysis. World J Gastroenterol. 2013;19(37):6284–91.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hu DM, Gong TT, Zhu Q. Endoscopic ultrasound elastography for differential diagnosis of pancreatic masses: a meta-analysis. Dig Dis Sci. 2013;58(4):1125–31.

    Article  PubMed  Google Scholar 

  15. Mei M, et al. EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis. Gastrointest Endosc. 2013;77(4):578–89.

    Article  PubMed  Google Scholar 

  16. Xu W, et al. Endoscopic ultrasound elastography for differentiation of benign and malignant pancreatic masses: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2013;25(2):218–24.

    Article  PubMed  Google Scholar 

  17. Ying L, et al. Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: a meta-analysis. J Gastroenterol Hepatol. 2013;28(9):1434–43.

    Article  PubMed  Google Scholar 

  18. Cui XW, et al. Endoscopic ultrasound elastography: current status and future perspectives. World J Gastroenterol. 2015;21(47):13212–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Giovannini M, et al. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy. 2006;38(4):344–8.

    Article  CAS  PubMed  Google Scholar 

  20. Soares JB, et al. Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions. Endosc Ultrasound. 2015;4(3):244–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chantarojanasiri T, Kongkam P. Endoscopic ultrasound elastography for solid pancreatic lesions. World J Gastrointest Endosc. 2017;9(10):506–13.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Iglesias-Garcia J, et al. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc. 2009;70(6):1101–8.

    Article  PubMed  Google Scholar 

  23. Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc. 2007;65(7):971–8.

    Article  PubMed  Google Scholar 

  24. Hirche TO, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy. 2008;40(11):910–7.

    Article  CAS  PubMed  Google Scholar 

  25. Săftoiu A, et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer. Gastrointest Endosc. 2008;68(6):1086–94.

    Article  PubMed  Google Scholar 

  26. Săftoiu A, et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011;43(7):596–603.

    Article  PubMed  Google Scholar 

  27. Schrader H, et al. Diagnostic value of quantitative EUS elastography for malignant pancreatic tumors: relationship with pancreatic fibrosis. Ultraschall Med. 2012;33(7):E196–e201.

    Article  CAS  PubMed  Google Scholar 

  28. Săftoiu A, et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc. 2010;72(4):739–47.

    Article  PubMed  Google Scholar 

  29. Hocke M, Ignee A, Dietrich CF. Advanced endosonographic diagnostic tools for discrimination of focal chronic pancreatitis and pancreatic carcinoma--elastography, contrast enhanced high mechanical index (CEHMI) and low mechanical index (CELMI) endosonography in direct comparison. Z Gastroenterol. 2012;50(2):199–203.

    Article  CAS  PubMed  Google Scholar 

  30. Chantarojanasiri T, et al. Endoscopic ultrasound in diagnosis of solid pancreatic lesions: elastography or contrast-enhanced harmonic alone versus the combination. Endosc Int Open. 2017;5(11):E1136–e1143.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Iglesias-Garcia J, et al. Differential diagnosis of solid pancreatic masses: contrast-enhanced harmonic (CEH-EUS), quantitative-elastography (QE-EUS), or both? United European Gastroenterol J. 2017;5(2):236–46.

    Article  PubMed  Google Scholar 

  32. Walczyk J, Sowa-Staszczak A. Diagnostic imaging of gastrointestinal neuroendocrine neoplasms with a focus on ultrasound. J Ultrason. 2019;19(78):228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jenssen C, et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV - EUS-guided Interventions: general aspects and EUS-guided sampling (long version). Ultraschall Med. 2016;37(2):E33–76.

    CAS  PubMed  Google Scholar 

  34. Lee TH, Cha SW, Cho YD. EUS elastography: advances in diagnostic EUS of the pancreas. Korean J Radiol. 2012;13(Suppl 1):S12–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hirota M, et al. The seventh nationwide epidemiological survey for chronic pancreatitis in Japan: clinical significance of smoking habit in Japanese patients. Pancreatology. 2014;14(6):490–6.

    Article  PubMed  Google Scholar 

  36. Catalano MF, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69(7):1251–61.

    Article  PubMed  Google Scholar 

  37. Kuwahara T, et al. Usefulness of shear wave elastography as a quantitative diagnosis of chronic pancreatitis. J Gastroenterol Hepatol. 2018;33(3):756–61.

    Article  PubMed  Google Scholar 

  38. Iglesias-Garcia J, et al. Quantitative elastography associated with endoscopic ultrasound for the diagnosis of chronic pancreatitis. Endoscopy. 2013;45(10):781–8.

    Article  PubMed  Google Scholar 

  39. Yamashita Y, et al. Utility of elastography with endoscopic ultrasonography shear-wave measurement for diagnosing chronic pancreatitis. Gut Liv. 2020;14:659.

    Article  Google Scholar 

  40. Dominguez-Muñoz JE, et al. EUS elastography to predict pancreatic exocrine insufficiency in patients with chronic pancreatitis. Gastrointest Endosc. 2015;81(1):136–42.

    Article  PubMed  Google Scholar 

  41. Shimosegawa T, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352–8.

    Article  PubMed  Google Scholar 

  42. Church NI, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102(11):2417–25.

    Article  CAS  PubMed  Google Scholar 

  43. Abraham SC, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all ‘chronic pancreatitis’? Am J Surg Pathol. 2003;27(1):110–20.

    Article  PubMed  Google Scholar 

  44. Weber SM, et al. Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg. 2003;7(1):129–37; discussion 137–9.

    Article  PubMed  Google Scholar 

  45. Barone JE. Pancreaticoduodenectomy for presumed pancreatic cancer. Surg Oncol. 2008;17(2):139–44.

    Article  PubMed  Google Scholar 

  46. de Castro SM, et al. Incidence and characteristics of chronic and lymphoplasmacytic sclerosing pancreatitis in patients scheduled to undergo a pancreatoduodenectomy. HPB (Oxford). 2010;12(1):15–21.

    Article  Google Scholar 

  47. van Heerde MJ, et al. Prevalence of autoimmune pancreatitis and other benign disorders in pancreatoduodenectomy for presumed malignancy of the pancreatic head. Dig Dis Sci. 2012;57(9):2458–65.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ishikawa T, et al. Usefulness of endoscopic ultrasound elastography combined with the strain ratio in the estimation of treatment effect in autoimmune pancreatitis. Pancreas. 2020;49:e21–2.

    Article  PubMed  Google Scholar 

  49. Dietrich CF, et al. Real-time tissue elastography in the diagnosis of autoimmune pancreatitis. Endoscopy. 2009;41(8):718–20.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology and Endoscopy Unit, Istituti Clinici Zucchi, Monza, Italy

    Federica Cavalcoli

  2. Gastrointestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori and Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy

    Roberta Elisa Rossi

  3. Gastroenterology Unit, San Gerardo Hospital, University of Milano – Bicocca, Monza, Italy

    Sara Massironi

Authors
  1. Federica Cavalcoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Elisa Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Massironi
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Mirella Fraquelli

Ethics declarations

No conflicting interests (including but not limited to commercial, personal, political, intellectual, or religious interests) to declare.

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cavalcoli, F., Rossi, R.E., Massironi, S. (2021). Endoscopic Ultrasound Elastography in Pancreatic Diseases. In: Fraquelli, M. (eds) Elastography of the Liver and Beyond. Springer, Cham. https://doi.org/10.1007/978-3-030-74132-7_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74132-7_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74131-0

  • Online ISBN: 978-3-030-74132-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation