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- Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects
- Clement Chun Ho Wu, Samuel Jun Ming Lim, Damien Meng Yew Tan
- Clin Endosc 2024;57(4):434-445. Published online July 8, 2024
- DOI: https://doi.org/10.5946/ce.2023.157
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Abstract
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ePub - Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.
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Citations
Citations to this article as recorded by
- Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
Journal of Digestive Endoscopy.2026;[Epub] CrossRef - Cystic neoplasms of pancreas
Krithi Krishna Koduri, Jahangeer Basha, Sundeep Lakhtakia
Indian Journal of Gastroenterology.2026;[Epub] CrossRef - Endoscopic techniques for the diagnosis of pancreatic cystic lesions
Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Jahnvi Dhar, Jayanta Samanta, Gabriele Capurso, Ivo Boskoski, Cristiano Spada, Jorge D Machicado, Stefano Francesco Crinò, Antonio Facciorusso
World Journal of Gastroenterology.2025;[Epub] CrossRef - Endoscopic ultrasound through-the-needle biopsy of pancreatic cystic neoplasms: Update on indications, safety profile, and research directions
Joana Mota, Tiago Ribeiro, Maria Cristina Conti Bellocchi, Nicolò De Pretis, Luca Frulloni, Joanne Lopes, Sokol Sina, Jahnvi Dhar, Jayanta Samanta, Guilherme Macedo, Filipe Vilas-Boas, Stefano Francesco Crinò
Best Practice & Research Clinical Gastroenterology.2025; : 102058. CrossRef - Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino, Giovanni Lombardi
Gastroenterology Insights.2024; 15(3): 810. CrossRef
- Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
- 8,890 View
- 265 Download
- 4 Web of Science
- 5 Crossref
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Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management
- Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor
- Clin Endosc 2023;56(4):433-445. Published online July 17, 2023
- DOI: https://doi.org/10.5946/ce.2023.013
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Abstract
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Supplementary MaterialPubReaderePub - Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.
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Citations
Citations to this article as recorded by- Global research trends on endoscopic bariatric surgery: bibliometric analysis over past 2 decades
Linjing Li, Kun Zhou, Hang Yin, Rongrong Bi, Lei Wang
Updates in Surgery.2026;[Epub] CrossRef - Is the Success Rate of Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Sphincterotomy Done for Bile Duct Stones Optimal?
Ciprani Debora, Amar Hoda, Abusharar Majd, Lopes Trisha, Karmarkar Rahi, Almadi Ahmed, Aroori Somaiah
Digestive Diseases and Sciences.2026; 71(2): 672. CrossRef - rs928508 of miR-30c-5p is Associated With the Risk of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Yunyun Sun, Xia Li, Liang Chen, Jun Zhang
Pancreas.2026; 55(1): e112. CrossRef - Radiomics analysis based on MRCP for predicting post-ERCP pancreatitis in patients with common bile duct stones
Sheng Chen, Yiyi Jin, Yonghui Wu, Chaotao Tang, Youxiang Chen
Surgical Endoscopy.2026; 40(3): 2447. CrossRef - An interpretable machine learning model for predicting the risk of post-endoscopic retrograde cholangiopancreatography complications in elderly patients with choledocholithiasis
Guanjun Zhang, Ke Meng, Yaqi Zhai, Min Zhu, Yuming Han, Mingyang Li
Saudi Journal of Gastroenterology.2026; 32(3): 228. CrossRef - Nationwide Survey on Endoscopic Papillectomy for Ampullary Adenoma: Current Practices and Variability
Hyung Ku Chon, Ik Hyun Jo, Sungjo Bang, Kihyun Ryu, Dong Wook Lee, Eaum Seok Lee, Yoon Suk Lee, Jonghyun Lee, Huapyong Kang, Tae Joo Jeon, Chang Hwan Park
Gut and Liver.2026; 20(2): 326. CrossRef - Dissolving the problem: Biodegradable stents as a value-driven strategy for post-ERCP pancreatitis prophylaxis in high-risk patients
Clement Wu, Venkata Akshintala
Pancreatology.2026; 26(3): 337. CrossRef - Topical tranexamic acid and sucralfate prevent delayed bleeding after endoscopic sphincterotomy: a randomized controlled trial (with video)
Hsueh-Chien Chiang, Jui-Wen Kang, Wei-Lun Chang, Tzu-Ling Kuo, Chien-Ming Chiang, Juei-Seng Wu, Po-Jun Chen, Chiao-Hsiung Chuang, Chiung-Yu Chen, Xi-Zhang Lin, Meng-Ying Lin
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef - Ускладнення лікувальної ендоскопічної ретроградної холангіопанкреатографії у хворих на холедохолітіаз
V. A. Katsal, M. A. Hudz, T. V. Formanchuk, V. V. Balabuieva, V. A. Maliuha, M. V. Kushkova
Reports of Vinnytsia National Medical University.2026; 30(1): 73. CrossRef - Clinical predictive modeling for post-ERCP cholangitis in biliary stricture patients
Bensong Duan, Weixin Ye, Yuping Shi, Suhong Yi, Dadong Wan, Yang Jiang, Liqian Xuan, Jiangfeng Hu
Frontiers in Medicine.2026;[Epub] CrossRef - Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with and without diabetes: a meta-analysis
Fang Jia, Fujing Lv, Shutian Zhang
Surgical Endoscopy.2025; 39(2): 807. CrossRef - Small common bile duct - the risk factor for post-ercp pancreatitis in patients with choledocholithiasis
Ivan Mamontov, Tamara Tamm, Kostiantyn Kramarenko, Dmytro Ryabushchenko, Dmytro Sytnik, Samer Dghaili
Wiadomości Lekarskie.2025; 77(12): 2388. CrossRef - Multidisciplinary Therapeutic Approaches to Pancreatic Cancer According to the Resectability Status
Aurelio Mauro, Carlotta Faverio, Leonardo Brizzi, Stefano Mazza, Davide Scalvini, Daniele Alfieri, Alessandro Cappellini, Fabio Chicco, Carlo Ciccioli, Claudia Delogu, Marco Bardone, Anna Gallotti, Anna Pagani, Francesca Torello Viera, Andrea Anderloni
Journal of Clinical Medicine.2025; 14(4): 1167. CrossRef - Effect of periampullary diverticulum morphology on ERCP cannulation and clinical results
Yavuz Cagir, Muhammed Bahaddin Durak, Cem Simsek, Ilhami Yuksel
Scandinavian Journal of Gastroenterology.2025; 60(4): 292. CrossRef - Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants
Mitsushige Sugimoto, Masaki Murata, Kento Shionoya, Takayoshi Tsuchiya, Takao Itoi
Digestive Endoscopy.2025; 37(7): 733. CrossRef - A Report of a Rare Case of Choledocholithiasis Complicated by Proximal Basket Rod Rupture Requiring Surgical Intervention
Alexandre Gomes
Cureus.2025;[Epub] CrossRef - Development of a Checklist for Evaluating Pancreatobiliary Endoscopy Training Facilities and Educational Programs
Hyung Ku Chon, Sung-Jo Bang, Eaum Seok Lee, Tae Ju Jeon, Chang Hwan Park
The Korean Journal of Pancreas and Biliary Tract.2025; 30(2): 93. CrossRef - Burden and cost of post–endoscopic retrograde cholangiopancreatography pancreatitis among commercially insured people undergoing endoscopic retrograde cholangiopancreatography
Anna Tavakkoli, Kandice A. Kapinos, B. Joseph Elmunzer, Richard S. Kwon, David M. Troendle, Song Zhang, Amit G. Singal
Gastrointestinal Endoscopy.2025; 102(5): 692. CrossRef - Preprocedural score system for post-ERCP pancreatitis risk stratification in patients with billiary obstruction
I.М. Mamontov, D.D. Riabushchenko, Т.І. Tamm, K.О. Kramarenko, S. Dghaili, V.V. Nepomniashchyi
Український радіологічний та онкологічний журнал.2025; 33(1): 9. CrossRef - Prevalence and Characteristics of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Complications in Patients With Biliopancreatic Disorders: A Retrospective Study
Jose Luis Vallejo Romero, Yazmin Cardenas Ramos, Floricel Olimpia Villegas Amador, Sandra Allison Barrueta Orive, Erick Mauricio Aldana Carbajal, Maria Guadalupe Ramirez Lugo, Karen Andrea Martinez Martinez, Diana Laura Montiel Covarrubias, Luis Eduardo N
Cureus.2025;[Epub] CrossRef - Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Complications: A Systematic Review of Microbial Patterns, Incidence, Risk Factors, and Management Strategies in Contemporary Practice
Anmar Al-Kabban, Fadi M Al-Kabban, Ola Obaid
Cureus.2025;[Epub] CrossRef - A Comprehensive Review of Digestive Endoscopy-Associated Infections: Bacterial Pathogens, Host Susceptibility, and the Impact of Viral Hepatitis
Deniz Günșahin, Vasile Șandru, Gabriel Constantinescu, Mădălina Ilie, Teodor Cabel, Ramona Ștefania Popescu, Bogdan Silviu Ungureanu, Victor Daniel Miron, Gheorghe G. Balan, Diana Cotigă, Bogdan Miutescu, Gülşen Özkaya Şahin, Oana Săndulescu
Microorganisms.2025; 13(9): 2128. CrossRef - Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography
Mehmet Simsar, Yesim Yekta Yuruk, Olgun Sahin, Hilal Sahin
World Journal of Radiology.2025;[Epub] CrossRef - Efficacy and safety of cap-assisted colonoscopy in endoscopic retrograde cholangiopancreatography for patients after Billroth II gastrectomy
Chun-Xiao Hu, Sheng-Yue Zhou, Xiao-Hua Ye
World Chinese Journal of Digestology.2025; 33(9): 707. CrossRef - Efficacy of hydration combined with rectal non-steroidal anti-inflammatory drugs (NSAIDs) versus NSAIDs alone for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis of randomized contr
Huimin Li, Changfeng Miao, Wei Fang, Yuan Deng, Xiong Li, Ting Du, Hongwei Tian
BMC Gastroenterology.2025;[Epub] CrossRef - Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy
Sung Yong Han, Min Jae Yang, Kyong Joo Lee, Jonghyun Lee, Se Woo Park
World Journal of Gastroenterology.2025;[Epub] CrossRef - Combination use of intravenous ketamine-midazolam as a sedative agent in endoscopic retrograde cholangiopancreatography: a randomized control trial
Rajdave Singh Sadu Singh, Azlanudin Azman, Jegan Thanabalan, Chik Ian, Boo Han Sin, Razman Jarmin, Fahrol Fahmy Jaafar
Scientific Reports.2025;[Epub] CrossRef - Identifying high-risk patients having ERCP as a day surgery with an online prediction platform: Multicohort validation of a machine learning model
Boru Jin, Yi Wang, Xu Zhang, Jinyu Zhao, Wangping He, Kecheng Jin, Zhen Liu, Ruyang Zhong, Yuhu Ma, Chunlu Dong, Yanyan Lin, Xiaoliang Zhu, Kexiang Zhu, Lei Zhang, Ping Yue, Shuyan Li, Jinqiu Yuan, Xun Li, Wenbo Meng
Endoscopy International Open.2025;[Epub] CrossRef - Prevention of post-ERCP complications
Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
Best Practice & Research Clinical Gastroenterology.2024; 69: 101906. CrossRef - International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef - Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef - Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network
Tsuyoshi Hamada, Koichiro Yasaka, Yousuke Nakai, Rintaro Fukuda, Ryunosuke Hakuta, Kazunaga Ishigaki, Sachiko Kanai, Kensaku Noguchi, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Naminatsu Takahara, Hiroyuki Isayama, Osamu Abe, Mitsuhiro
Endoscopy International Open.2024; 12(06): E772. CrossRef - IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef - International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef - Risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography: a retrospective single-center study
I.М. Mamontov, D.D. Rjabushhenko, Т.І. Tamm, К.О. Kramarenko, V.V. Nepomniashchyi, A.T. Ustinov
Український радіологічний та онкологічний журнал.2024; 32(3): 287. CrossRef - Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
Jae Min Lee
The Korean Journal of Internal Medicine.2023; 38(6): 783. CrossRef
- Global research trends on endoscopic bariatric surgery: bibliometric analysis over past 2 decades
- 18,223 View
- 679 Download
- 28 Web of Science
- 36 Crossref
- The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review
- Yung Ka Chin, Clement Chun Ho Wu, Damien Meng Yew Tan
- Clin Endosc 2021;54(1):38-47. Published online March 31, 2020
- DOI: https://doi.org/10.5946/ce.2019.200-IDEN
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Abstract
PDFPubReaderePub
- The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
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Citations
Citations to this article as recorded by- Identifying Neoplastic Versus Non-neoplastic Pancreatic Cystic Lesions—What Is the Current Evidence?
Arjun Chatterjee, Renan Prado, Clifton G. Fulmer, Christopher Coppa, Daniel Joyce, Syed Mohiuddin, Prabhleen Chahal, Tyler Stevens
Digestive Diseases and Sciences.2025; 70(10): 3246. CrossRef - Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression
Yan Hu, Dan Jones, Ashwini K. Esnakula, Somashekar G. Krishna, Wei Chen
Cancers.2024; 16(6): 1183. CrossRef - Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases
Jia Huang, Xiaofei Fan, Wentian Liu
Diagnostics.2023; 13(17): 2815. CrossRef - EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts
Michele T. Yip-Schneider, Rodica Muraru, Rachel C. Kim, Howard H. Wu, Stuart Sherman, Aditya Gutta, Mohammad A. Al-Haddad, John M. Dewitt, C. Max Schmidt
HPB.2023; 25(12): 1587. CrossRef - Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey
Hyung Ku Chon, Sung Hoon Moon, Sang Wook Park, Woo Hyun Paik, Chang Nyol Paik, Byoung Kwan Son, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Jae Min Lee, Tae Joo Jeon, Chang-Hwan Park, Kwang Bum Cho, Dong Wook Lee
The Korean Journal of Internal Medicine.2022; 37(1): 63. CrossRef - Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral
Clinical Endoscopy.2022; 55(2): 197. CrossRef - Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions
Jorge D. Machicado, Bertrand Napoleon, Anne Marie Lennon, Samer El-Dika, Stephen P. Pereira, Damien Tan, Rahul Pannala, Mohit Girotra, Pradermchai Kongkam, Helga Bertani, Yunlu Feng, Hao Sijie, Ning Zhong, Vincent Valantin, Sarah Leblanc, Alice Hinton, So
Pancreatology.2022; 22(7): 994. CrossRef - Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics
Wei Chen, Nehaal Ahmed, Somashekar G. Krishna
Diagnostics.2022; 13(1): 65. CrossRef - Diagnostic Value of Endomicroscopy for Gastrointestinal Diseases: New Possibilities and Concepts
Ralf Kiesslich
Techniques and Innovations in Gastrointestinal Endoscopy.2021; 23(1): 57. CrossRef
- Identifying Neoplastic Versus Non-neoplastic Pancreatic Cystic Lesions—What Is the Current Evidence?
- 9,375 View
- 243 Download
- 10 Web of Science
- 9 Crossref
Commentary
- Intraductal Ultrasonography Can Enhance the Success of Endoscopic Transpapillary Gallbladder Drainage in Patients with Acute Cholecystitis
- Clement Chun Ho Wu, Christopher Jen Lock Khor
- Clin Endosc 2020;53(2):114-116. Published online March 30, 2020
- DOI: https://doi.org/10.5946/ce.2020.051
- 4,685 View
- 73 Download
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