Laurenza C, Zignani N, Elvo B, Pignata L, Frigo F, Di Luna I, Soro S, Dagani D, Drago A, Grassia R. Reference range of pancreatic strain histogram by endoscopic ultrasound elastography: A pilot study. World J Gastrointest Endosc 2026; 18(4): 118422 [DOI: 10.4253/wjge.v18.i4.118422]
Corresponding Author of This Article
Nunzio Zignani, MD, Department of Pathophysiology and Transplantation, University of Milan, Via Festa Del Perdono 7, Milan 20122, Lombardy, Italy. zignani.nunzio@gmail.com
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Gastroenterology & Hepatology
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Observational Study
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Apr 16, 2026 (publication date) through Apr 16, 2026
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Laurenza C, Zignani N, Elvo B, Pignata L, Frigo F, Di Luna I, Soro S, Dagani D, Drago A, Grassia R. Reference range of pancreatic strain histogram by endoscopic ultrasound elastography: A pilot study. World J Gastrointest Endosc 2026; 18(4): 118422 [DOI: 10.4253/wjge.v18.i4.118422]
World J Gastrointest Endosc. Apr 16, 2026; 18(4): 118422 Published online Apr 16, 2026. doi: 10.4253/wjge.v18.i4.118422
Reference range of pancreatic strain histogram by endoscopic ultrasound elastography: A pilot study
Carmen Laurenza, Nunzio Zignani, Biagio Elvo, Luca Pignata, Francesco Frigo, Imma Di Luna, Sara Soro, Dario Dagani, Andrea Drago, Roberto Grassia
Carmen Laurenza, Biagio Elvo, Luca Pignata, Francesco Frigo, Imma Di Luna, Sara Soro, Andrea Drago, Roberto Grassia, Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Lombardy, Italy
Nunzio Zignani, Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Lombardy, Italy
Dario Dagani, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia 27100, Lombardy, Italy
Author contributions: Laurenza C, Zignani N, Elvo B, Di Luna I, Soro S, and Dagani D participated in the performance of the research; Laurenza C, Zignani N, and Dagani D contributed to data analysis and original draft; Laurenza C, Zignani N, and Grassia R participated in research design the study; Pignata L, Frigo F, Drago A, and Grassia R participated in critical revision; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Declaration of Helsinki.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: The data collected in this study are not publicly available for consultation as they are protected by the privacy regulations in force at our institution.
Corresponding author: Nunzio Zignani, MD, Department of Pathophysiology and Transplantation, University of Milan, Via Festa Del Perdono 7, Milan 20122, Lombardy, Italy. zignani.nunzio@gmail.com
Received: January 2, 2026 Revised: January 19, 2026 Accepted: February 26, 2026 Published online: April 16, 2026 Processing time: 102 Days and 16.5 Hours
Abstract
BACKGROUND
The increasing incidence and economic burden of pancreatic diseases highlight the urgent need for improved diagnostic tools. While advanced imaging modalities such as endoscopic ultrasound (EUS) and magnetic resonance imaging are effective in evaluating focal lesions and late-stage chronic pancreatitis (CP), diagnosing early CP remains challenging due to the lack of high-specificity, non-invasive methods. EUS-elastography is an emerging technique used to quantify tissue stiffness, which correlates with pancreatic fibrosis.
AIM
To utilize strain histogram (SH) analysis, a semi-quantitative EUS-elastography method, to establish a reference range of SH values in a cohort of healthy controls and to compare them with a group of patients with confirmed CP.
METHODS
We consecutively enrolled patients undergoing EUS, applying strict exclusion criteria to select subjects without pancreatic masses or ductal anomalies. SH values were measured three times in each of the three main pancreatic regions (head, body, and tail). In addition, demographic data, smoking habits, and alcohol abuse status were collected. Statistical analysis included descriptive statistics, inferential tests (t-test and χ2), to identify potential differences between the control group and the CP group, and to analyze associations between SH values and other variables.
RESULTS
The study analyzed 143 patients (95 healthy controls, 48 with CP). No significant differences were found in demographics such as age, sex, or body mass index between the subgroups. However, patients with CP exhibited significantly greater pancreatic stiffness, reflected by lower total SH values compared to the healthy cohort (72 vs 116, P < 0.01). In addition, a higher prevalence of smoking and a slight increase in alcohol abuse were observed in CP patients (P < 0.01 and P = 0.07, respectively). Finally, no sex-based differences were found within the two subgroups.
CONCLUSION
SH analysis effectively differentiates pancreatic stiffness between healthy individuals and CP patients, offering potential reference values for early diagnosis. This simple and safe technique aids in the identification of preclinical pathological changes. Future large-scale studies are required for external validation.
Core Tip: This pilot study evaluates endoscopic ultrasound-elastography using strain histogram (SH) analysis to improve the diagnosis of chronic pancreatitis (CP), which remains challenging in its early stages. The study compared 95 healthy controls with 48 CP patients to establish reference stiffness values. Results showed that CP patients had significantly higher pancreatic stiffness, indicated by lower SH values compared to healthy subjects (median 72 vs 116, P < 0.01). In conclusion, SH analysis effectively differentiates healthy tissue from CP, providing a safe tool for identifying preclinical pathological changes.
