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Thomas J. Wang 1 Article
Defining the optimal technique for endoscopic ultrasound shear wave elastography: a combined benchtop and animal model study with comparison to transabdominal shear wave elastography
Thomas J. Wang, Marvin Ryou
Clin Endosc 2023;56(2):229-238.   Published online February 28, 2023
AbstractAbstract PDFSupplementary MaterialPubReaderePub
/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.
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.
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.
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.


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.2024;[Epub]     CrossRef
  • Response
    Divyanshoo R. Kohli, Mohammad Shadab Siddiqui
    Gastrointestinal Endoscopy.2024; 100(1): 161.     CrossRef
  • Standardization of endoscopic ultrasound shear wave elastography
    Julio Iglesias-García, J. Enrique Domínguez-Muñoz
    Clinical Endoscopy.2023; 56(2): 185.     CrossRef
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