Cholangioscopy is an important tool, adjunctive  to endoscopic retrograde cholangiopancreatography (ERCP),for cases that cannot otherwise be adequately evaluated or treated. Both single-operator peroral cholangioscopy (SOC) and percutaneous transhepatic cholangioscopy are available in our center. Our aim is  to describe our experience with cholangioscopy, including  safety and efficacy across various indications

We retrospectively collected data from patients who underwent cholangioscopy from 2023 to 2025 and recorded demographics, medical history, ERCP–cholangioscopy procedure details (description–video–images), and complications such as cholangitis, pancreatitis, perforation, or bleeding that prolonged hospitalization for >2 days.

A total of 24 patients were included. Their mean age was 66.2 ± 11.6 years, and 10/24 (42%) were women. Fifteen patients (62.5%) had undergone a prior ERCP. Difficult choledocholithiasis was the indication in 6 procedures (20.8%); in 5/6, ERCP had previously failed to clear the common bile duct (CBD), which had a diameter >20 mm. In cholangioscopy procedures for choledocholithiasis, electrohydraulic lithotripsy was performed, and in 3 of these cases multiple balloon trawls and basket stone retrievals were also carried out. In the remaining 18/24 cases, the indication was indeterminate biliary strictures. Three cases were approached percutaneously via a transhepatic route due to altered anatomy, and three involved anastomotic strictures in liver-transplant recipients. Sphincteroplasty was required in 7/24 patients (29%), and biliary stents were placed in 20/24 (83%). Complications occurred in 9/24 (37.5%) patients, while the median length of hospitalization after cholangioscopy was 2 (IQR 3) days. Age, sex, sphincteroplasty, stent placement, prior ERCP, or the indication for cholangioscopy were not significantly associated with the development of complications (P > 0.620).

Cholangioscopy is an effective procedure with acceptable safety, which can assist in the diagnostic evaluation and management of challenging biliary cases in clinical practice.