BACKGROUND AND AIMS: Noninvasive assessment of liver fibrosis is important in the management of liver disease. EUS-guided shear wave elastography (EUS-SWE) is a newer technology that can measure liver stiffness, thereby estimating hepatic fibrosis. There are limited data comparing EUS-SWE to vibration-controlled transient elastography (VCTE) using liver biopsy as the reference standard, and the reproducibility of EUS-SWE measurements is not known. METHODS: In total, 52 patients referred for EUS-guided liver biopsy (EUS-LB) were prospectively enrolled. Patients first underwent VCTE, then 2 consecutive EUS-SWE measurements done first in the left and then another 2 in the right. Bilobar EUS-LB was then done. Receiver operating characteristic curves were developed to compare EUS-SWE to VCTE and correlate to histology. Analysis was performed to determine EUS-SWE variability in paired measurements for each lobe and between right and left liver lobes. RESULTS: The most common indication for EUS-LB was non-alcoholic steatohepatitis fibrosis staging in 46% of patients. Right lobe SWE had a strong correlation with fibrosis stage ρ = 0.571 (P <
.0002) whereas left lobe EUS-SWE had a moderate correlation ρ = 0.368 (P <
.0079). Both EUS-SWE and VCTE were similar for discrimination of all stages of fibrosis based on empiric receiver operating characteristic curves. However, the variance between paired consecutive EUS-SWE measurements was 3.5 times higher in the left lobe compared to the right lobe (P <
.0002). CONCLUSION: EUS-SWE provides an assessment of hepatic fibrosis comparable to VCTE. EUS-SWE in the left lobe has 3.5 times higher variance between consecutive measurements compared to the right.