EUS-Guided ATI and SWE in Individuals With Normal FibroScan (EUS ATI&SWE)

July 15, 2026 updated by: Mohan Ramchandani, Asian Institute of Gastroenterology, India

"EUS-Guided Attenuation Imaging and Shear Wave Elastography in Individuals With Normal FibroScan: Establishing Preliminary Reference Values in a Pilot Feasibility Study".

The goal of this observational study is to establish preliminary reference values for Endoscopic Ultrasound (EUS)-guided Attenuation Imaging (ATI) and Shear Wave Elastography (SWE) in adults undergoing diagnostic EUS for non-hepatobiliary indications who have normal FibroScan findings. The main questions it aims to answer are:

What are the preliminary normal reference values for EUS-guided ATI in the right and left hepatic lobes? What are the preliminary normal reference values for EUS-guided SWE elasticity (kPa) and velocity (m/s) in the right and left hepatic lobes?

Participants will:

Undergo same-day FibroScan assessment to confirm normal liver stiffness and steatosis parameters.

Undergo EUS-guided ATI and SWE measurements of both the right and left hepatic lobes during their clinically indicated diagnostic EUS examination.

Have demographic, clinical, and laboratory information recorded for analysis.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Vibration-controlled transient elastography (FibroScan) with Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) is widely used for the non-invasive assessment of liver fibrosis and steatosis. Although these techniques have demonstrated good diagnostic performance, they have several limitations, including technical failure in obese individuals, reduced accuracy in the presence of ascites or narrow intercostal spaces, and the inability to obtain real-time image-guided measurements from specific areas of the liver.

Endoscopic ultrasound (EUS) provides high-resolution imaging of both hepatic lobes through the stomach and duodenum, allowing quantitative assessment of liver tissue under direct visualization. Recent advances have enabled the integration of Attenuation Imaging (ATI), which quantifies hepatic steatosis, and Shear Wave Elastography (SWE), which measures liver stiffness by estimating tissue elasticity and shear wave velocity, into EUS platforms. These techniques may overcome several limitations of conventional transabdominal elastography and have the potential to provide more reliable liver tissue characterization.

Before EUS-guided ATI and SWE can be evaluated as diagnostic tools for liver disease, normal reference values in individuals without liver disease must be established. Currently, there are limited data regarding normal EUS-guided ATI and SWE measurements, particularly in healthy adults with normal FibroScan findings. Establishing these reference ranges is essential for interpreting future studies involving patients with hepatic steatosis and chronic liver disease.

This prospective, single-center, observational pilot feasibility study aims to establish preliminary reference values for EUS-guided ATI and SWE in adults undergoing diagnostic EUS for non-hepatobiliary indications who have normal FibroScan examinations. A total of 100 participants will be enrolled after confirming normal liver stiffness (LSM <7.5 kPa) and steatosis (CAP <238 dB/m), along with adequate FibroScan quality criteria.

During the clinically indicated EUS examination, quantitative liver assessment will be performed without introducing additional invasive procedures beyond standard EUS. Attenuation Imaging will be obtained from both the right and left hepatic lobes, with five valid measurements acquired per lobe. Shear Wave Elastography will also be performed in both lobes, with ten valid measurements obtained per lobe. Measurements will be accepted only if predefined quality criteria are met, including acceptable correlation coefficients, propagation maps, and reliability indices. Acquisition time, technical success, and measurement reproducibility will also be recorded.

The primary outcome of the study is to establish preliminary reference values for EUS-guided ATI, SWE elasticity (kPa), and SWE velocity (m/s) for both hepatic lobes. Secondary objectives include evaluating the technical feasibility and reliability of EUS-guided quantitative liver assessment, assessing agreement between right and left hepatic lobe measurements, determining correlations between ATI and FibroScan CAP, evaluating correlations between SWE and FibroScan LSM, and documenting acquisition times for both techniques.

The findings from this pilot study will provide foundational reference data for EUS-guided quantitative liver imaging and support the design of larger validation studies investigating the role of EUS-guided ATI and SWE in the diagnosis and monitoring of hepatic steatosis and fibrosis.

Study Type

Observational

Enrollment (Estimated)

100

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • India
    • Telangana
      • Hyderabad, Telangana, India, 500032
        • AIG Hospitals
        • Contact:
        • Principal Investigator:
          • Dr. Sundeep Lakhtakia, MD, DM
        • Sub-Investigator:
          • Dr. Anudeep Katrevula, MD, DM
        • Sub-Investigator:
          • Dr. Jahangeer Basha, MD, DM

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Adults aged 18 years or older undergoing clinically indicated diagnostic endoscopic ultrasound (EUS) for non-hepatobiliary indications at AIG Hospitals will be screened for eligibility. Participants with normal FibroScan findings, defined as a Controlled Attenuation Parameter (CAP) <238 dB/m and Liver Stiffness Measurement (LSM) <7.5 kPa, who meet all eligibility criteria and provide written informed consent will be enrolled in the study.

Description

Inclusion Criteria:

  • Adults aged 18 years or older.
  • Undergoing clinically indicated diagnostic endoscopic ultrasound (EUS).
  • Same-day FibroScan examination available.
  • Controlled Attenuation Parameter (CAP) <238 dB/m.
  • Liver Stiffness Measurement (LSM) <7.5 kPa.
  • At least 10 valid FibroScan measurements.
  • FibroScan interquartile range (IQR)/median ≤30%.
  • Able and willing to provide written informed consent.

Exclusion Criteria:

  • Known chronic liver disease.
  • Hepatitis B or Hepatitis C infection.
  • Significant alcohol consumption.
  • Decompensated cirrhosis.
  • Portal vein thrombosis.
  • Ascites.
  • Focal liver lesion.
  • Previous liver surgery.
  • Pregnancy.
  • Inadequate FibroScan examination.
  • Poor-quality EUS-guided Attenuation Imaging (ATI) or Shear Wave Elastography (SWE) acquisition.
  • Incomplete study data or withdrawal of informed consent.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Normal FibroScan Cohort
Adults aged 18 years or older undergoing clinically indicated diagnostic endoscopic ultrasound (EUS) for non-hepatobiliary indications who have normal FibroScan findings (Controlled Attenuation Parameter [CAP] <238 dB/m and Liver Stiffness Measurement [LSM] <7.5 kPa). Participants will undergo EUS-guided Attenuation Imaging (ATI) and Shear Wave Elastography (SWE) of the right and left hepatic lobes during the same EUS procedure to establish preliminary reference values and assess the feasibility and reliability of these quantitative imaging techniques.
Procedure: Endoscopic Ultrasound (EUS)
A clinically indicated diagnostic endoscopic ultrasound will be performed according to standard institutional practice. During the examination, the liver will be visualized from the stomach and duodenum to allow quantitative liver assessment.
Procedure: EUS-guided Attenuation Imaging (ATI)
Attenuation Imaging (ATI) will be performed during the diagnostic EUS to quantitatively assess hepatic steatosis. Five valid ATI measurements will be obtained from both the right and left hepatic lobes under direct EUS visualization. Measurements meeting predefined quality criteria will be used for analysis.
Procedure: EUS-Guided Shear Wave Elastography (SWE)
Shear Wave Elastography (SWE) will be performed during the diagnostic EUS to assess liver stiffness. Ten valid measurements will be obtained from both the right and left hepatic lobes. Shear wave velocity (m/s) and tissue elasticity (kPa) will be recorded, and only measurements meeting predefined quality criteria will be included in the analysis.
Procedure: FibroScan
Participants will undergo same-day FibroScan examination before EUS to confirm normal liver stiffness and steatosis. Controlled Attenuation Parameter (CAP) and Liver Stiffness Measurement (LSM) will be recorded, with at least 10 valid measurements and acceptable quality metrics required for study eligibility.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Reference values for EUS-guided Attenuation Imaging (ATI)
Time Frame: During the index EUS procedure (Day 0)
To establish preliminary reference values for EUS-guided Attenuation Imaging (ATI) in the right and left hepatic lobes of adults with normal FibroScan findings. ATI values will be reported as mean ± standard deviation (SD), median (interquartile range [IQR]), and 95% reference intervals.
During the index EUS procedure (Day 0)
Reference values for EUS-guided Shear Wave Elastography (SWE) elasticity
Time Frame: During the index EUS procedure (Day 0)
To establish preliminary reference values for EUS-guided SWE elasticity (kPa) in the right and left hepatic lobes. Results will be reported as mean ± SD, median (IQR), and 95% reference intervals.
During the index EUS procedure (Day 0)
Reference values for EUS-guided Shear Wave Elastography (SWE) velocity
Time Frame: During the index EUS procedure (Day 0)
To establish preliminary reference values for EUS-guided SWE shear wave velocity (m/s) in the right and left hepatic lobes. Results will be reported as mean ± SD, median (IQR), and 95% reference intervals.
During the index EUS procedure (Day 0)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Technical success rate
Time Frame: During the index EUS procedure (Day 0)
To determine the proportion of participants in whom acceptable EUS-guided ATI and SWE measurements are successfully acquired according to predefined quality criteria.
During the index EUS procedure (Day 0)
Measurement reliability
Time Frame: During the index EUS procedure (Day 0)
To evaluate the reliability and reproducibility of EUS-guided ATI and SWE measurements using predefined quality parameters.
During the index EUS procedure (Day 0)
Agreement between right and left hepatic lobe measurements
Time Frame: During the index EUS procedure (Day 0)
To assess agreement between ATI and SWE measurements obtained from the right and left hepatic lobes.
During the index EUS procedure (Day 0)
Correlation between ATI and FibroScan CAP
Time Frame: During the index EUS procedure (Day 0)
To evaluate the correlation between EUS-guided ATI measurements and FibroScan Controlled Attenuation Parameter (CAP).
During the index EUS procedure (Day 0)
Correlation between SWE and FibroScan Liver Stiffness Measurement (LSM)
Time Frame: During the index EUS procedure (Day 0)
To evaluate the correlation between EUS-guided SWE measurements and FibroScan Liver Stiffness Measurement (LSM).
During the index EUS procedure (Day 0)
Acquisition time
Time Frame: During the index EUS procedure (Day 0)
To determine the time required to complete EUS-guided ATI and SWE measurements during the diagnostic EUS examination.
During the index EUS procedure (Day 0)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Asian Institute of Gastroenterology, India

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 20, 2026

Primary Completion (Estimated)

August 30, 2027

Study Completion (Estimated)

September 20, 2027

Study Registration Dates

First Submitted

July 15, 2026

First Submitted That Met QC Criteria

July 15, 2026

First Posted (Actual)

July 20, 2026

Study Record Updates

Last Update Posted (Actual)

July 20, 2026

Last Update Submitted That Met QC Criteria

July 15, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • EUS-ATI&SWE

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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