The aim of our study was to assess the utility of endoscopic ultrasonography (EUS) and contrast-enhanced EUS (CE-EUS) for the depiction and differential diagnosis of pancreatic tumors focusing in particularly those 2 cm or smaller. We compared different diagnostic procedures, contrast-enhanced multidetector computed tomography (CE-CT) and EUS with the use of power Doppler (PD-EUS) and CE-EUS for detection and differential diagnosis of pancreatic tumors. The study included 156 consecutive patients with suspected pancreatic tumors, who underwent CE-CT, and EUS followed by PD-EUS and CE-EUS. CE-EUS was performed by power Doppler mode using sonographic contrast agent Levovist. Thirty-six of 156 patients examined had tumors of < or =2 cm. EUS had significantly higher sensitivity (94.4%) for detection of pancreatic carcinomas of 2 cm or less in comparison to CE-CT (50%). For small pancreatic tumor of 2 cm or less, sensitivities for differentiating ductal carcinomas from other tumors were 50.0%, 11.0% and 83.3% for CE-CT, PD-EUS and CE-EUS. CE-EUS was significantly more sensitive than PD-EUS and CE-CT. EUS and subsequent CE-EUS are more sensitive than CE-CT in the detection and the differentiation of small pancreatic tumors.