**7. Contrast‐enhanced endoscopic ultrasound (CE‐EUS)**

CE‐EUS combines the benefits of high‐resolution US to those of a contrast‐enhanced imaging method. It has two subtypes with similar performance: contrast‐enhanced endoscopic Doppler ultrasound (which uses a high mechanical index for examination and no special software) and contrast‐enhanced low mechanical index endoscopic ultrasound (in which the examination is made in contrast mode) [51]. CE‐EUS in Doppler mode is useful to differentiate between ductal adenocarcinomas (in which only arterioles are seen] and pseudotumoral chronic pancreatitis (in which both arterioles and venules can be identified by CE‐EUS Doppler) [52, 53].

CE‐EUS with low mechanical index has been used similarly to transabdominal CEUS to differentiate between pseudotumoral CP and ductal adenocarcinoma, but also to guide FNA in order to avoid avascular areas, improving the diagnostic accuracy of FNA [54]. Quantitative postprocedural assessment of uptake of the contrast agent has been proven useful to improve the accuracy of CE‐EUS with low mechanical index for differentiating between the two entities [55, 56].

**As a conclusion**, we must cite the EFSUMB guidelines on the nonhepatic use of CEUS, which state that CEUS is useful to improve characterization of ductal adenocarcinoma (A;1b); to differentiate between pseudocysts and cystic tumors (A;1b); to differentiate vascular (solid) from avascular (liquid/necrotic) components of a lesion (A;1b); to better define the dimensions and margins of a lesion, including its relationship with adjacent vessels (B;2b); to help the choice for a next imaging technique (C;5) [1].
