Preoperative Endoscopic Ultrasound Strain Elastography Has Limited Value for Predicting Intraoperative Pancreatic Texture: A Single-Operator Pilot Study.

Background/Aims: Soft pancreatic texture is a key risk factor for postoperative pancreatic fistula (POPF). However, preoperative quantification remains difficult. Intraoperative palpation is the current standard for assessing pancreatic hardness; however, this technique is not feasible in robot-assisted surgery. We prospectively evaluated whether endoscopic ultrasound strain elastography (EUS-SE) could predict pancreatic hardness. Methods: Nine consecutive patients scheduled for pancreatectomies underwent preoperative EUS-SE. The strain ratio (SR) values from the nontumorous parenchyma were compared using intraoperative palpation (soft vs. hard). A receiver operating characteristic (ROC) analysis was used to determine the optimal SR cutoff. The associations between computed tomography (CT) attenuation, fibrosis, and postoperative outcomes were examined. Results: Six pancreases were classified as soft, and three pancreases were classified as hard. The median SR was identical in both groups (6.0; interquartile range [IQR] of 4.7-7.7 vs. 5.5-6.3; Conclusion: In this pilot study, preoperative EUS-SE did not predict intraoperative pancreatic textures. Strain-based elastography alone appears to be insufficient for hardness stratification and should be complemented by more quantitative modalities.