Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy

Background Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (EUS‐EG), which objectively assesses tissue elasticity, predict the development of PF following PD. Methods Fifty‐nine patients who underwent EUS‐EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated. Results Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut‐off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008). Conclusions Endoscopic ultrasonography‐elastography may be an accurate and objective method for predicting PF following PD. Highlight Kuwahara and colleagues evaluated the efficacy of endoscopic ultrasonography‐guided elastography, which allows objective assessment of tissue elasticity, in predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. The mean elasticity of the body of the pancreas calculated using histogram analysis was found to correlate with the postoperative incidence of pancreatic fistula.