Thirty patients underwent EUS examination with elastography for evaluation of pancreatic masses. They were 22 males and 8 females with a mean age of 54±8.6 years. The final histological assessment was based on the FNA, surgical and endoscopic biopsy results. Eleven cases were diagnosed by FNA, 5 cases were diagnosed by surgical exploration and pathological results, 4 cases were diagnosed by following up the size of masses. In 5 cases, major vessels were found to be involved. Two cases were having distant metastasis, and three cases were diagnosed with endoscopic biopsy. The final diagnosis of the pancreatic masses included pancreatic malignant masses (n = 25), pancreatitis (n = 2), papillary adenoma (n = 2) and papillary carcinoma (n =1). The elastographic images were interpreted as benign (score 1 + 2) in 2 cases, score 3 in 6 cases and malignant (score 4 + 5) in 22 cases. Considering score 3 as benign, the calculated sensitivity, specificity, positive and negative predictive values were: 88%, 80%, 95.6% and 57.14% respectively, with a global accuracy of this new technology of 89.2%. Considering score 3 as malignant, the calculated sensitivity, specificity, positive and negative predictive values of EUS elastography were 100%, 40%, 89.28% and 100 respectively. EUS correctly diagnosed 23 cases with malignant pancreatic lesions while one case diagnosed as malignant was finally proved benign. EUS also correctly diagnosed 4 benign cases. Two cases were indeterminate on EUS diagnosis, one was proved to be benign and one was proved to be malignant on final diagnosis.The calculated sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS in diagnosing pancreatic masses were 95.8%, 83.3%, 95.8%, 83.3%, 90% and 90% respectively when the indeterminate cases were considered as benign. On the other hand, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 66.6%, 92.3%, 100% and 93.3% respectively when the indeterminate cases were considered as malignant.When adding tissue elastography to EUS diagnosis, the sensitivity, specificity, positive predictive value, negative predictive and accuracy improved to become 100%, 80%, 96.2%, 100% and 96.7% respectively.