Endoscopic ultrasound elastography in diagnosing chronic pancreatitis: has the strain ratio found its region of interest?

Endoscopic ultrasonography (EUS) imaging of chronic pancreatitis (CP) was first reported in 1986 - and a recent systematic review retrieved 51 articles in the last decade (January 2001-January 2010) vs. 13 articles in the previous 20 years (1980-2000). Despite this abundant literature, the role of EUS in CP is still far from being well established. CP has traditionally been regarded as a difficult terrain in the setting of EUS both because it is difficult to diagnose per se, particularly in its early stages, and because it induces artifacts hampering the detection of pancreatic neoplasms. Moreover, changes seen on EUS might be early ones and don’t necessarily reflect function; hence, there was always diversion between EUS findings and their clinical relevance, accusing EUS of over diagnosing CP.