Modern endoscopic strategies for the diagnosis and management of cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) presents considerable diagnostic and therapeutic challenges for the endoscopist. This review offers a focused and practical evaluation of contemporary endoscopic approaches for the diagnosis and management of CCA, with an emphasis on real-world applicability and integration into clinical workflows. We highlight the central role of endoscopic retrograde cholangiopancreatography, along with the expanding utility of cholangioscopy and endoscopic ultrasound, which have led to important improvements in the yield of tissue acquisition. On the therapeutic front, we critically examine modern endoscopic biliary drainage strategies in managing complex biliary strictures. Through a synthesis of current evidence and expert consensus, we present algorithmic approaches tailored to anatomical and clinical scenarios, providing actionable insights for gastroenterologists, advanced endoscopists and multidisciplinary teams. Ultimately, this review underscores how recent advances in endoscopic technology are reshaping the management landscape of CCA, translating innovation into effective, patient-centred care.