Endosonographic Shear Wave Elastography for Liver Stiffness

Inclusion Criteria: * Patients referred for EUS guided liver biopsy * Elevated liver enzymes without obvious etiology, thus necessitating liver biopsy or clinical concern for cirrhosis or NASH requiring histological confirmation * Ability to provide informed consent and willing to participate Exclusion Criteria: * Clinical evidence of cirrhosis which obviates need for liver biopsy * Noninvasive lab testing which confirms presence of cirrhosis * Surgically altered foregut anatomy which precludes safe endoscopic liver biopsy * Coagulopathy with INR greater than 1.6 in patients on anticoagulant therapy * Thrombocytopenia with platelet count less than 50,000/mL * Pregnancy (positive urine pregnancy test in females of childbearing age) * Lack of consent