Advances in endoscopic ultrasound-guided shear wave elastography: A comprehensive review of its clinical applications

Abstract

Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) represents a significant advancement in non-invasive tissue characterization, enabling objective assessment of quantitative tissue stiffness in real-time with potential clinical relevance across a variety of gastrointestinal disorders. Recent developments in EUS-SWE have expanded its application beyond hepatic fibrosis to include pancreatic diseases and the evaluation of solid tumors. EUS-SWE has demonstrated diagnostic accuracy comparable to vibration-controlled transient elastography in assessing fibrosis stages, positioning it as a potential alternative to liver biopsy. Moreover, EUS-SWE has shown promise in evaluating pancreatic tissue stiffness, aiding in the diagnosis and monitoring of chronic pancreatitis and pancreatic cancer. This technique offers a distinct advantage by allowing tissue stiffness measurements during the same procedure, thereby reducing the need for additional imaging studies and biopsies. Despite its clinical potential, challenges remain, including the need for standardized protocols, optimal cutoff values, and validation across diverse patient populations. This minireview provides a comprehensive analysis of the current literature on EUS-SWE, examining its diagnostic performance, reproducibility, and limitations. Furthermore, we discuss the future directions of EUS-SWE, including its integration into routine clinical practice and its evolving role in precision medicine, emphasizing the necessity of large-scale studies to solidify its clinical utility and establish standardized guidelines for its use.

Keywords: Endoscopic ultrasound; Shear wave elastography; Chronic pancreatitis; Autoimmune pancreatitis; Liver fibrosis

Core Tip: Endoscopic ultrasound (EUS)-guided shear wave elastography provides real-time, quantitative assessment of tissue stiffness during standard EUS examinations. Current evidence supports its value in staging chronic pancreatitis, monitoring autoimmune pancreatitis, and assessing liver fibrosis with diagnostic accuracy comparable to vibration-controlled transient elastography. While feasibility and reproducibility are consistently high, the lack of standardized protocols and validated cut-off values limits routine application. Large-scale prospective studies are essential to define its role in clinical practice and establish EUS-shear wave elastography as a reliable tool in precision gastroenterology.