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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(04): 220-228
DOI: 10.1055/s-0045-1811646
Narrative Review

Practical Applications of Endoscopic Ultrasound-Guided Elastography: Core Principles, Techniques, and Pitfalls

Authors

  • Nikhil Sonthalia

    1   Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

  • Awanish Tewari

    1   Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

  • Akash Roy

    1   Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

  • Uday C. Ghoshal

    1   Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India

  • Mahesh K. Goenka

    1   Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
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Abstract

Recent advancements in endoscopic technology have established endoscopic ultrasonography (EUS) as a valuable tool for gastroenterologists. The integration of complementary imaging techniques, such as contrast enhancement and elastography, has significantly enhanced the capabilities of EUS. EUS-guided elastography (EUS-E) is an innovative imaging modality that improves the diagnostic accuracy of standard B-mode EUS by measuring the mechanical properties of tissues, particularly their elasticity or stiffness. These measurements are indicative of pathological changes and can aid in differentiating benign from malignant tissues. By combining elastography with EUS, it is now possible to assess tissue stiffness in organs such as the liver, pancreas, and lymph nodes. This approach not only aids in differential diagnosis but also enables the identification of the most accurate areas for EUS-guided tissue acquisition. EUS-E is performed using two main techniques: strain elastography and shear wave elastography, each with distinct advantages and limitations. This article provides an in-depth review of EUS-E, including its principles, techniques, clinical applications, and inherent limitations.

Keywords

endoscopic ultrasonography - EUS-guided elastography - shear wave elastography - liver stiffness - EUS-guided fine needle aspiration/biopsy

Declaration of GenAI use

The authors acknowledge the use of ChatGPT for language polishing of the manuscript.


Authors' Contributions

N.S., A.T., A.R., and U.C.G. performed literature review and data collection; N.S. and A.T. wrote the manuscript; A.R., M.K.G., and U.C.G. performed critical review of the manuscript; N.S., A.R., M.K.G., and U.C.G. contributed to editing and final approval of the manuscript.




Publication History

Article published online:
08 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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