Purpose <p>The purpose of this study was to evaluate hepatic and pancreatic steatosis on grey-scale ultrasound and assess its association with hepatic and pancreatic stiffness using ultrasound 2D-shear wave elastography (2D-SWE) in patients with metabolic syndrome (MS).</p> Methods <p>One hundred and thirty-one adult patients with metabolic syndrome were included in the study. Grey scale ultrasound of liver and pancreas was performed to evaluate grades of hepatic steatosis (HS) and pancreatic steatosis (PS) respectively. Subsequently, 2D-SWE was performed to obtain liver and pancreatic stiffness in kPa and m/s. Grades of HS and PS were correlated with body mass index (BMI), biochemical parameters, hepatic and pancreatic stiffness values.</p> Results <p>Moderate correlation was found between HS grade and BMI, while the correlation of PS grade with BMI was poor. On SWE, hepatic and pancreatic stiffness showed strong and moderate correlation with BMI, respectively. Among biochemical parameters, triglycerides showed highest correlation with HS grade and hepatic stiffness, while fasting blood glucose showed highest correlation with PS grade and pancreatic stiffness. The stiffness values of both organs showed statistically significant difference in participant groups with and without steatosis (<i>p</i> &lt; 0.001). Mean hepatic and pancreatic stiffness values showed strong positive correlation with grade of HS (Ʈ=0.84) and PS (Ʈ=0.82), respectively.</p> Conclusion <p>Metabolic syndrome is associated with both hepatic and pancreatic steatosis with consequent increase in hepatic and pancreatic stiffness values respectively. These values show positive correlation with the grade of steatosis. 2D-SWE along with biochemical parameters, can be utilized in the screening of MS patients for early detection and surveillance of further disease progression to prevent potential complications.</p>