Advanced Imaging Within the Bile Duct During Endoscopic Retrograde Cholangiopancreatography

Despite innovation in bile duct imaging over the past 2 decades, indeterminate biliary strictures remain a diagnostic challenge. The prototypical case is a patient who presents with a bile duct stricture, usually symptomatic, but no discrete mass is identified on cross-sectional imaging. The differential diagnosis includes cholangiocarcinoma; other malignancies; and fibroinflammatory causes, such as primary sclerosing cholangitis and autoimmune cholangiopathy. How has recent innovation changed the approach to these patients?