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Defining the optimal technique for endoscopic ultrasound shear wave elastography: a combined benchtop and animal model study with comparison to transabdominal shear wave elastography
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Thomas J. Wang, Marvin Ryou
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Clin Endosc 2023;56(2):229-238. Published online February 28, 2023
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DOI: https://doi.org/10.5946/ce.2022.135
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 Abstract
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- Background
/Aims: Shear wave elastography (SWE) is used for liver fibrosis staging based on stiffness measurements. It can be performed using endoscopic ultrasound (EUS) or a transabdominal approach. Transabdominal accuracy can be limited in patients with obesity because of the thick abdomen. Theoretically, EUS-SWE overcomes this limitation by internally assessing the liver. We aimed to define the optimal technique for EUS-SWE for future research and clinical use and compare its accuracy with that of transabdominal SWE.
Methods
Benchtop study: A standardized phantom model was used. The compared variables included the region of interest (ROI) size, depth, and orientation and transducer pressure.
Porcine study: Phantom models with varying stiffness values were surgically implanted between the hepatic lobes.
Results
For EUS-SWE, a larger ROI size of 1.5 cm and a smaller ROI depth of 1 cm demonstrated a significantly higher accuracy. For transabdominal SWE, the ROI size was nonadjustable, and the optimal ROI depth ranged from 2 to 4 cm. The transducer pressure and ROI orientation did not significantly affect the accuracy. There were no significant differences in the accuracy between transabdominal SWE and EUS-SWE in the animal model. The variability among the operators was more pronounced for the higher stiffness values. Small lesion measurements were accurate only when the ROI was entirely situated within the lesion.
Conclusions
We defined the optimal viewing windows for EUS-SWE and transabdominal SWE. The accuracy was comparable in the non-obese porcine model. EUS-SWE may have a higher utility for evaluating small lesions than transabdominal SWE.
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Citations
Citations to this article as recorded by  - Endoscopic Ultrasound-based Shear Wave Elastography for Detection of Advanced Liver Disease
Jad AbiMansour, Jerry Yung-Lun Chin, Jyotroop Kaur, Eric J. Vargas, Barham K. Abu Dayyeh, Ryan Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Sudhakar Venkatesh, Vinay Chandrasekhara
Journal of Clinical Gastroenterology.2025; 59(3): 256. CrossRef - EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction–associated steatotic liver disease: a pilot study (with video)
Thomas J. Wang, Pichamol Jirapinyo, Raj Shah, Kimberly Schuster, David J. Papke, Christopher C. Thompson, Laura Doyon, David B. Lautz, Marvin Ryou
Gastrointestinal Endoscopy.2025; 101(2): 456. CrossRef - Reproducibility of EUS-guided shear wave elastography for assessment of hepatic fibrosis: a prospective pilot cohort study
David L. Diehl, Vikas Sangwan, Sandeep Khurana, Harshit S. Khara, Jianying Zhang, Bradley D. Confer
Gastrointestinal Endoscopy.2025; 101(3): 659. CrossRef - Endoscopic Ultrasound–Guided Portosystemic Pressure Gradient Correlates with Clinical Parameters and Liver Histology
Jennifer M. Kolb, Marc Monachese, Raymond A. Rubin, Thomas J. Wang, Alyssa Choi, Ahmad N. Bazarbashi, Bhaumik Brahmbhatt, Ali Zakaria, Pedro Cortes, Varun Kesar, William F. Abel, Wen-Pin Chen, Christine McLaren, Amirali Tavangar, Amit G. Singal, Pushpak T
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef - Response
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Gastrointestinal Endoscopy.2024; 100(1): 161. CrossRef - Advancements and challenges in gastrointestinal imaging
Eun Jeong Gong, Chang Seok Bang
World Journal of Clinical Cases.2024; 12(33): 6591. CrossRef - The Role of Endoscopic Ultrasound-Guided Shear Wave Elastography in Pancreatic Diseases
Yazan Abboud, Srinivas Gaddam
Diagnostics.2024; 14(20): 2329. CrossRef - EUS-based shear wave elastography of the spleen for detection of clinically significant portal hypertension
Jad P. AbiMansour, Jerry Yung-Lun Chin, Eric J. Vargas, Jyotroop Kaur, Barham K. Abu Dayyeh, Ryan J. Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Vinay Chandrasekhara
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Clinical Endoscopy.2023; 56(2): 185. CrossRef
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