Preoperative Endoscopic Ultrasound Strain Elastography Has Limited Value for Predicting Intraoperative Pancreatic...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Imaging

Background:

• Pancreatic texture hardness is crucial for predicting postoperative pancreatic fistula (POPF).
• Preoperative quantification of pancreatic hardness is challenging.
• Intraoperative palpation, the current standard, is not feasible in robot-assisted surgery.

Purpose of the Study:

• To evaluate the potential of endoscopic ultrasound strain elastography (EUS-SE) in predicting preoperative pancreatic hardness.

Main Methods:

• Prospective evaluation of EUS-SE in nine patients undergoing pancreatectomy.
• Comparison of strain ratio (SR) values with intraoperative palpation findings.
• Receiver operating characteristic (ROC) analysis to determine SR cutoff and assess discriminatory ability.
• Examination of correlations between SR, CT attenuation, fibrosis, and POPF.

Main Results:

• EUS-SE did not differentiate between soft and hard pancreases (median SR: 6.0 vs. 5.5-6.3, p=1.000).
• The ROC-derived SR cutoff of 7.0 showed no discriminatory ability (AUC=0.500).
• SR did not correlate with CT attenuation, fibrosis, or POPF.

Conclusions:

• Preoperative EUS-SE, in its current strain-based form, is insufficient for predicting intraoperative pancreatic texture.
• Quantitative elastography modalities are needed to complement strain-based elastography for hardness stratification.