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Because the diagnostic sensitivity and accuracy of standard endoscopic retrograde cholangiopancreatography\u2010based tissue sampling for malignancy are suboptimal, additional endoscopic evaluation by cholangioscopy and\/or endoscopic ultrasound (EUS) is often necessary to differentiate between malignant and benign biliary strictures to guide clinical management. While direct visualization by cholangioscopy and\/or high\u2010resolution imaging by EUS are often the first step in the evaluation of an indeterminate biliary stricture (IDBS), tissue diagnosis by cholangioscopy\u2010guided biopsy and\/or EUS\u2010guided fine\u2010needle tissue acquisition is the preferred modality to establish a diagnosis of malignancy. Because each modality has its own strengths and limitations, selection of cholangioscopy and EUS is best guided by the\u00a0biliary stricture location and local expertise. Artificial intelligence\u2010assisted diagnosis, biopsy forceps with improved design, contrast\u2010enhanced EUS, and dedicated fine\u2010needle biopsy devices are recent technological advances that may further improve the diagnostic performance of cholangioscopy and EUS in patients with IDBS.<\/jats:p>","DOI":"10.1111\/den.14733","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T08:50:57Z","timestamp":1701161457000},"page":"778-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both?"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-8036","authenticated-orcid":false,"given":"Raymond S. 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