Assessment of Intra-Individual Variability and Reproducibility in Pancreatic EUS-Guided Elastography

Background: Shear-wave elastography (SWE) performed during endoscopic ultrasound (EUS) is a promising tool for quantifying pancreatic stiffness, but its intra-session reproducibility remains incompletely defined. Methods: In this prospective single-center study, 86 consecutive patients (median age 66 years; 59.3% women) referred for diagnostic EUS underwent EUS-guided point SWE. Ten measurements were acquired from a 10 × 15 mm region of interest in the pancreatic body or tail when the breath was held by a single expert operator. Reproducibility was assessed by comparing the first and last five acquisitions; intra-individual variability was expressed as the coefficient of variation (CV). Results: Mean stiffness was 18.5 ± 8.9 kPa (2.31 ± 0.58 m/s). Agreement between early and late measurements was excellent in kPa (ICC = 0.99; r = 0.997; mean bias -0.06 kPa) and moderate in m/s (ICC = 0.61; r = 0.61). The mean CVs were 0.640 for kPa and 0.328 for m/s. Sex, age, and BMI had no significant influence on stiffness or reproducibility. The technical success rate was 97%, with no adverse events. Conclusions: EUS-guided point SWE provides highly reproducible pancreatic stiffness measurements within a single session, particularly when expressed in kPa. Demographic factors do not affect stability, supporting its integration into routine EUS practice. Further multicenter studies are needed to establish pathology-specific cut-offs and confirm clinical relevance.