The Expanding Role of Contrast-Enhanced Endoscopic Ultrasound in Pancreatobiliary Disease

Since its introduction into clinical practice in the 1980s, endo-scopic ultrasound (EUS) has been described as a good imag-ing modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobi-liary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index tech-niques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, avail-ability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and fur-ther development of this technique. (Gut Liver 2015;9:707