Comparative Analysis of Endoscopic Ultrasound Elastography and FibroScan in Diagnosing Liver Fibrosis and Cirrhosis

Background and study aim: Accurate, noninvasive assessment of liver fibrosis remains crucial for managing chronic liver disease. Endoscopic ultrasound (EUS) elastography has emerged as a potential complementary tool to transient elastography (TE), particularly for patients undergoing EUS for other indications. This study aimed to evaluate the diagnostic performance of EUS elastography in assessing hepatic and splenic stiffness among patients with hepatitis C virus (HCV) infection and metabolic dysfunction–associated steatotic liver disease (MASLD).Patients and Methods: A prospective cross-sectional study was conducted involving 100 participants: 24 with chronic HCV infection, 41 with MASLD, and 35 without liver disease serving as controls. All participants underwent EUS elastography and TE assessment of liver and spleen stiffness.Results: The cohort had a mean age of 52 ± 10 years with balanced sex distribution; metabolic comorbidities such as diabetes mellitus and hypertension were most frequent in MASLD patients (41.5% and 19.5%, respectively).EUS liver stiffness correlated moderately with TE measurements but showed limited diagnostic discrimination in MASLD (AUC=0.545 for ≥F3) and modest accuracy in HCV (AU =0.685 for ≥F3). Conversely, EUS spleen elastography demonstrated excellent diagnostic performance in detecting advanced fibrosis among HCV patients (AUC=0.951 for ≥F3, 0.821 for ≥F4) and moderate accuracy in MASLD (AUC=0.653 for F0–F2).Conclusion: In patients already undergoing endoscopic ultrasound, EUS elastography—particularly evaluation of spleen stiffness—offers promising diagnostic insight into liver fibrosis and portal hypertension. While transient elastography remains the benchmark for non-invasive fibrosis staging, EUS-based elastography can serve as a supportive modality integrated into standard EUS workflows for targeted liver disease evaluation.