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Abstract Background and aims Endoscopic ultrasound (EUS) elastography is a novel non-invasive technique that can be used for distinguishing benign from malignant pancreatic masses. However, the studies have reported widely varied sensitivities and specificities. A meta-analysis was performed to assess the performance of EUS elastography for the differentiation of benign and malignant pancreatic masses. Methods All the eligible studies were searched by PubMed, Medline, Embase, and the Cochrane Library. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and area under the curve (AUC) were calculated to examine the accuracy. Results A total of nineteen studies which included 1687 patients were analyzed. The pooled sensitivity and specificity for the diagnosis of malignant pancreatic masses were 0.98 (95% confidence interval [CI] 0.96–0.99) and 0.63 (95% CI 0.58–0.69) for qualitative EUS elastography, 0.95 (95% CI 0.93–0.97) and 0.61 (95% CI 0.56–0.66) for quantitative EUS elastography, respectively. The positive and negative LR were 2.60 (95% CI 1.84–3.66) and 0.05 (95% CI 0.02–0.10) for qualitative EUS elastography, 2.64 (95% CI 1.82–3.82) and 0.10 (95% CI 0.06–0.16) for quantitative EUS elastography, respectively. The summary diagnostic odds ratio (DOR) and the AUC were 60.59 (95% CI 28.12–130.56) and 0.91 (Q* = 0.842) for qualitative EUS elastography, 30.09 (95% CI 15.40–58.76) and 0.93 (Q* = 0.860) for quantitative EUS elastography. Conclusions Our meta-analysis shows that both qualitative and quantitative EUS elastography have high accuracy in the detection of malignant pancreatic masses, which could be used as a valuable complementary method to EUS-FNA for the differentiation of pancreatic masses in the future. [ABSTRACT FROM AUTHOR]