{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T13:21:02Z","timestamp":1773667262998,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Endoscopic retrograde cholangiopancreatography (ERCP) is the cornerstone in the management of choledocholithiasis. Despite continuous advancements in technique and safety, ERCP carries a risk of significant complications, underscoring the importance of avoiding unnecessary procedures. The principal contributor to potentially avoidable ERCPs in patients with known choledocholithiasis is the spontaneous passage of common bile duct stones. Small stone size and a long interval between diagnosis and the procedure have increasingly been found to favor this event. Moreover, despite the development of well-defined risk stratification scores for patients with suspected choledocholithiasis, the incidence of negative ERCPs within this patient population remains considerable, even when a high suspicion of choledocholithiasis is evident. This review summarizes current evidence on the incidence and predictors of avoidable ERCPs in these contexts, with particular emphasis on spontaneous stone passage. It also discusses the role of endoscopic ultrasound (EUS) as a diagnostic tool to reduce unnecessary procedures when initial imaging fails to confirm the presence of stones despite persistent high clinical suspicion. By integrating and critically appraising recent findings, we provide practical guidance for clinicians on decision-making regarding ERCP, particularly in situations where spontaneous stone passage is likely or imaging results are inconclusive.<\/jats:p>","DOI":"10.3390\/medicina62030548","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T11:13:14Z","timestamp":1773659594000},"page":"548","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unnecessary ERCPs: Is Spontaneous Stone Passage the Sole Determinant?"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3103-2638","authenticated-orcid":false,"given":"Dimitrios I.","family":"Ziogas","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece"},{"name":"Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8383-825X","authenticated-orcid":false,"given":"Theodoros A.","family":"Voulgaris","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ance","family":"Volkanovska","sequence":"additional","affiliation":[{"name":"University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, 12345 Skopje, North Macedonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliki","family":"Stamou","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece"},{"name":"Second Academic Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Kranidiotis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerasimos","family":"Stefanidis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-4013","authenticated-orcid":false,"given":"Paraskevas","family":"Gkolfakis","sequence":"additional","affiliation":[{"name":"Second Academic Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4976-4901","authenticated-orcid":false,"given":"Ioannis A.","family":"Vezakis","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Zografou Polytechnic Campus, 15772 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gjorgi","family":"Deriban","sequence":"additional","affiliation":[{"name":"University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, 12345 Skopje, North Macedonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meri","family":"Trajkovska","sequence":"additional","affiliation":[{"name":"University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, 12345 Skopje, North Macedonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-9426","authenticated-orcid":false,"given":"Konstantinos","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"Second Academic Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0958-7664","authenticated-orcid":false,"given":"Antonios","family":"Vezakis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-6168","authenticated-orcid":false,"given":"Ioannis S.","family":"Papanikolaou","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Second Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece"},{"name":"Second Academic Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"ASGE Standards of Practice Committee, Maple, J.T., Ben-Menachem, T., Anderson, M.A., Appalaneni, V., Banerjee, S., Cash, B.D., Fisher, L., Harrison, M.E., and Fanelli, R.D. (2010). The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest. Endosc., 71, 1\u20139.","DOI":"10.1016\/j.gie.2009.09.041"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0016-5107(91)70740-2","article-title":"Endoscopic sphincterotomy complications and their management: An attempt at consensus","volume":"37","author":"Cotton","year":"1991","journal-title":"Gastrointest. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"ref_5","first-page":"CD011549","article-title":"Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones","volume":"2015","author":"Giljaca","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"290","DOI":"10.5009\/gnl16052","article-title":"Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan","volume":"11","author":"Jeon","year":"2017","journal-title":"Gut Liver"},{"key":"ref_7","first-page":"1941","article-title":"The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis","volume":"7","author":"Mandelia","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/j.gie.2017.06.009","article-title":"Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: A meta-analysis of diagnostic test accuracy in head-to-head studies","volume":"86","author":"Meeralam","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.gie.2020.10.033","article-title":"Comparing diagnostic accuracy of current practice guidelines in predicting choledocholithiasis: Outcomes from a large healthcare system comprising both academic and community settings","volume":"93","author":"Chandran","year":"2021","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"269","DOI":"10.5946\/ce.2020.100","article-title":"Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis","volume":"54","author":"Jacob","year":"2021","journal-title":"Clin. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1055\/a-1117-3451","article-title":"Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy","volume":"52","author":"Jagtap","year":"2020","journal-title":"Endoscopy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3542","DOI":"10.1007\/s00464-021-08676-8","article-title":"The high rate of spontaneous migration of small size common bile duct stones may allow a significant reduction in unnecessary ERCP and related complications: Results of a retrospective, multicenter study","volume":"36","author":"Andreozzi","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4585","DOI":"10.1007\/s00464-023-09954-3","article-title":"Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: A multicenter retrospective study","volume":"37","author":"Saito","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2674","DOI":"10.1111\/jgh.70073","article-title":"Preventing Unnecessary Endoscopic Retrograde Cholangiopancreatography in Patients with Spontaneous Bile Duct Stone Passage: A Systematic Review and Meta-Analysis","volume":"40","author":"Arabpour","year":"2025","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/01.sla.0000103069.00170.9c","article-title":"A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: Natural history of choledocholithiasis revisited","volume":"239","author":"Collins","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/S0016-5107(00)70414-7","article-title":"Choledocholithiasis: A prospective study of spontaneous common bile duct stone migration","volume":"51","author":"Frossard","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S1499-3872(11)60033-7","article-title":"Spontaneous passage of common bile duct stones in jaundiced patients","volume":"10","author":"Lefemine","year":"2011","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.dld.2013.11.007","article-title":"Prospective evaluation of early endoscopic ultrasonography for triage in suspected choledocholithiasis: Results from a large single centre series","volume":"46","author":"Anderloni","year":"2014","journal-title":"Dig. Liver Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1007\/s00464-022-09615-x","article-title":"Suspected common bile duct stones: Reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP","volume":"37","author":"Verschoor","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.amsu.2020.10.040","article-title":"The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study","volume":"60","author":"Sanguanlosit","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Inan, B., Akbay, A., Guven, I.E., and Ersoy, O. (2024). Assessment of The Factors Related to The Spontaneous Passage of Common Bile Duct Stones. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092672"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.surge.2015.11.001","article-title":"Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP","volume":"15","author":"Reid","year":"2017","journal-title":"Surgeon"},{"key":"ref_23","first-page":"5382708","article-title":"Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study","volume":"2019","author":"Khoury","year":"2019","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102515","DOI":"10.1016\/j.clinre.2024.102515","article-title":"Predictive factors of spontaneous common bile duct clearance and unnecessary ERCP in patients with choledocholithiasis","volume":"49","author":"Correia","year":"2025","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1308\/003588403321661325","article-title":"Spontaneous passage of bile duct stones: Frequency of occurrence and relation to clinical presentation","volume":"85","author":"Tranter","year":"2003","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3283","DOI":"10.3748\/wjg.15.3283","article-title":"Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?","volume":"15","author":"Sakai","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3000605211058381","DOI":"10.1177\/03000605211058381","article-title":"Factors related to the spontaneous passage of common bile duct stones through the papilla: A single-center retrospective cohort study","volume":"49","author":"Ding","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.gie.2018.10.001","article-title":"ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis","volume":"89","author":"Committee","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_29","unstructured":"IAP\/APA\/EPC\/IPC\/JPS Working Group (2025). International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: Supported and Endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society. Pancreatology, 25, 770\u2013814."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/jhbp.509","article-title":"Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis","volume":"25","author":"Miura","year":"2018","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s10620-019-05970-3","article-title":"Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A \u201cScoping\u201d Literature Review","volume":"65","author":"Johnson","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"110269","DOI":"10.3748\/wjg.v31.i37.110269","article-title":"Endoscopic retrograde cholangiopancreatography in elderly patients: Is age just a number or something more?","volume":"31","author":"Voulgaris","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/jhbp.12178","article-title":"Higher Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Patients with Asymptomatic Common Bile Duct Stones Compared to Symptomatic Cases: A Propensity Score-Matched Cohort Analysis","volume":"32","author":"Kataoka","year":"2025","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1007\/s10620-022-07773-5","article-title":"Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones","volume":"68","author":"Saito","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_35","first-page":"a24750099","article-title":"Application of EUS or MRCP prior to ERCP in patients with suspected choledocholithiasis in clinical practice","volume":"13","author":"Engels","year":"2025","journal-title":"Endosc. Int. Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1007\/s11605-018-04090-z","article-title":"Prevalence and Predictors of Unnecessary Endoscopic Retrograde Cholangiopancreatography in the Two-Stage Endoscopic Stone Extraction Followed by Laparoscopic Cholecystectomy","volume":"23","author":"Lee","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.2169\/internalmedicine.2047-18","article-title":"Efficacy of the Endoscopic Ultrasound-first Approach in Patients with Suspected Common Bile Duct Stone to Avoid Unnecessary Endoscopic Retrograde Cholangiopancreatography","volume":"58","author":"Maruta","year":"2019","journal-title":"Intern. Med."},{"key":"ref_38","first-page":"309","article-title":"Accuracy of ASGE criteria for the prediction of choledocholithiasis","volume":"108","year":"2016","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"E599","DOI":"10.1055\/a-2089-0344","article-title":"Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis","volume":"11","author":"Shah","year":"2023","journal-title":"Endosc. Int. Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/jgh3.12773","article-title":"Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines\u2019 performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study","volume":"6","author":"Tunruttanakul","year":"2022","journal-title":"JGH Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/den.12994","article-title":"Current clinical algorithms for predicting common bile duct stones have only moderate accuracy","volume":"30","author":"Ebrahim","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4253\/wjge.v7.i2.128","article-title":"Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice","volume":"7","author":"Magalhaes","year":"2015","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"7233","DOI":"10.1007\/s00464-022-09089-x","article-title":"Accuracy of SAGES, ASGE, and ESGE criteria in predicting choledocholithiasis","volume":"36","author":"Wangchuk","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s12328-021-01575-4","article-title":"Systematic review and meta-analysis of the 2010 ASGE non-invasive predictors of choledocholithiasis and comparison to the 2019 ASGE predictors","volume":"15","author":"Wang","year":"2022","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.gie.2017.01.039","article-title":"Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones","volume":"86","author":"He","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lin, M.Y., Lee, C.T., Hsieh, M.T., Ou, M.C., Wang, Y.S., Lee, M.C., Chang, W.L., and Sheu, B.S. (2022). Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02162-8"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"592","DOI":"10.5946\/ce.2017.010","article-title":"Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study","volume":"50","author":"Patel","year":"2017","journal-title":"Clin. Endosc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s004640000146","article-title":"Routine vs \u201con demand\u201d postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis","volume":"14","author":"Ammori","year":"2000","journal-title":"Surg. Endosc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1001\/jamasurg.2014.249","article-title":"Natural course vs interventions to clear common bile duct stones: Data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks)","volume":"149","author":"Moller","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/MCG.0b013e31827130a7","article-title":"Role of endoscopic ultrasonography in patients with intermediate probability of choledocholithiasis but a negative CT scan","volume":"47","author":"Kim","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.bpg.2016.10.008","article-title":"Complications of diagnostic and therapeutic endoscopic ultrasound","volume":"30","author":"Lakhtakia","year":"2016","journal-title":"Best. Pract. Res. Clin. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"E1537","DOI":"10.1055\/a-1231-4948","article-title":"Test performance and predictors of accuracy of endoscopic ultrasound-guided fine-needle aspiration for diagnosing biliary strictures or masses","volume":"8","author":"Raine","year":"2020","journal-title":"Endosc. Int. Open"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/548\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T12:14:44Z","timestamp":1773663284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030548"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030548","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}