Early detection of pancreatic cancer is difficult and most of patients with pancreatic cancer present with locally advanced stage disease or distant metastasis on diagnosis. Micrometastasis occurs in the majority of pancreatic cancers larger than 2 cm in diameter and making early diagnosis and treatment essential to improve the prognosis. Small pancreatic tumors less than 2 cm in diameter can be missed on transcutaneous ultrasound

CT and MRI. Endoscopic ultrasound (EUS) has been considered the most sensitive modality in evaluation of pancreatic lesions. It can be placed in close proximity to the pancreas and provide real-time

high resolution imaging using a high frequency ultrasound probe to find lesions as small as 5 mm. Recently

small pancreatic tumors have been increasingly detected with the widely used EUS. The development of new techniques such as EUS elastography

contrast-enhanced harmonic EUS (CEH-EUS) and fine needle aspiration biopsy (EUS-FNAB) have enhanced the ability of EUS in detection of small solid pancreatic tumors as well as in differentiation of malignancies from benign tumors.