AbstractBackground: Investigate the clinical utility of contrast-enhanced endoscopic ultrasound (CEEUS) and endoscopicultrasound elastography (EUS-E) in diagnosis of pancreaticmasses.Patients and Methods: 30 patients with solid pancreaticfocal lesions were included. All patients were subjected tolaboratory investigations, conventional ultrasound, triphasiccomputed tomography (CT) scan, EUS-E, CEEUS, and EUSFNA. Diagnostic accuracy of EUS-E and CEEUS were com-pared and correlated to the pathology for pancreatic lesions.Results: Malignant lesions were larger in size (32.2±10.3), and had greater SR-E-EUS and more hypovascular pattern. The mean strain ratio was 16.4±8.14 for benign and 67.76 ± 72.45 for malignant lesions (p=0.001). Hypovascular pattern after contrast injection was present in 76% of malignant and 60% of benign lesions (p=0.66). ROC analysis for the mean SR-E-EUS of the region of interest yielded an optimal cutoff of 74.4 with an AUC of 0.91 (95% CI: 0.74-0.98) for the best power distinction for malignancy. It provided a sensitivity and specificity of 75% and 80%, respectively.Conclusion: EUS based novel modalities (CE-EUS andEUS-E) could distinguish between benign and malignantlesions and improve the identification of the vascular patternrespectively. Both techniques could be considered a comple-mentary imaging modality in the characterization of pancreatictumors.