Initially, EUS was a mechanical radial scanning method, but it has now become an electronic scanning method, and technologies used in transabdominal ultrasound, such as color / power Doppler imaging, have been applied to EUS. Evaluation of blood flow information by EUS has become possible. Furthermore, the introduction of the second-generation ultrasonic contrast agent Sonazoid® (Daiichi Sankyo Co., Ltd.), which was released in January 2007, is based on the property of generating second harmonic signals at low acoustic power. It enables long-term observation using the contrast harmonic imaging method and enables evaluation of minute blood flow information. In addition to fundamental B-mode observation, contrast-enhanced imaging with Sonazoid® under EUS can improve diagnostic ability for biliary and pancreatic diseases. This paper describes the actual method of contrast-enhanced EUS and its findings for major biliary and pancreatic diseases. Since the use of Sonazoid® for biliary and pancreatic diseases is not covered by insurance, it is necessary to obtain sufficient informed consent and implement it with the approval of the Institutional Review Board of the facility. In the future, if Sonazoid® insurance coverage is approved for biliary and pancreatic diseases, contrast-enhanced EUS is expected to further develop as a precise diagnostic method for the biliary and pancreatic region.
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