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Cholangioscopy was once often discussed but rarely performed. Modern, single-operator cholangioscopes have transformed this situation, and at many centers, cholangioscopy is now considered a routine adjunctive procedure to interventional endoscopic retrograde cholangiopancreatography (ERCP). Even for experts, it can be difficult to distinguish benign from malignant lesions based on their cholangioscopic appearance. A new classification system was recently studied to evaluate macroscopic bile duct lesions, based on their surface appearance, vascular pattern, and signs of inflammation, among other factors.
In the first stage of a two-stage protocol, investigators retrospectively compared cholangioscopy video recordings with biopsy in 65 patien…