Musalia JG, Alzayyat S, Aljahdli ES, Al-Lehibi A, Lara LF, Gabr M. Cholangioscopy in the diagnosis and management of cholangiocarcinoma. World J Gastrointest Endosc 2026; 18(3): 115412 [DOI: 10.4253/wjge.v18.i3.115412]
Corresponding Author of This Article
Moamen Gabr, MD, Assistant Professor, FACG, FASGE, Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, College of Medicine, 2600 Clifton Ave, Cincinnati, OH 45221, United States. gabrmn@ucmail.uc.edu
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Gastroenterology & Hepatology
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 16, 2026 (publication date) through Mar 17, 2026
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Musalia JG, Alzayyat S, Aljahdli ES, Al-Lehibi A, Lara LF, Gabr M. Cholangioscopy in the diagnosis and management of cholangiocarcinoma. World J Gastrointest Endosc 2026; 18(3): 115412 [DOI: 10.4253/wjge.v18.i3.115412]
World J Gastrointest Endosc. Mar 16, 2026; 18(3): 115412 Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.115412
Cholangioscopy in the diagnosis and management of cholangiocarcinoma
Joshua Gikenye Musalia, Sarah Alzayyat, Emad S Aljahdli, Abed Al-Lehibi, Luis F Lara, Moamen Gabr
Joshua Gikenye Musalia, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45219, United States
Sarah Alzayyat, College of Medicine, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland
Emad S Aljahdli, Department of Internal Medicine, Gastroenterology Division, King Abdulaziz University, Jeddah 20991, Mekkah, Saudi Arabia
Abed Al-Lehibi, Department of Gastroenterology and Hepatology, King Saud bin Abdulaziz University, Riyadh 11481, Ar Riyā, Saudi Arabia
Luis F Lara, Moamen Gabr, Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, College of Medicine, Cincinnati, OH 45221, United States
Co-first authors: Joshua Gikenye Musalia and Sarah Alzayyat.
Author contributions: Musalia JG and Alzayyat S performed the literature review and drafted the original manuscript, and they contributed equally to this manuscript and are co-first authors; Gabr M supervised the study; Gabr M, Aljahdli ES, Lara LF, and Al-Lehibi A provided expertise; and all authors reviewed and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Moamen Gabr, MD, Assistant Professor, FACG, FASGE, Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati, College of Medicine, 2600 Clifton Ave, Cincinnati, OH 45221, United States. gabrmn@ucmail.uc.edu
Received: October 17, 2025 Revised: November 24, 2025 Accepted: January 15, 2026 Published online: March 16, 2026 Processing time: 148 Days and 10.6 Hours
Abstract
Cholangiocarcinoma is a late-presenting and aggressive malignancy that remains difficult to diagnose and treat. Early detection remains challenging due to its insidious onset and nonspecific symptoms, which necessitate advancements in diagnostic and therapeutic strategies. Conventional imaging modalities often lack sufficient sensitivity, while endoscopic retrograde cholangioscopy-based sampling is limited by a low diagnostic yield. However, digital single-operator cholangioscopy has emerged as a transformative tool, significantly enhancing diagnostic accuracy through direct visualization, targeted biopsies, and standardized classification systems. Beyond its diagnostic applications, cholangioscopy plays a critical role in therapeutic interventions, facilitating precise biliary drainage, stent placement, and intraductal therapies such as photodynamic therapy and radiofrequency ablation. The integration of artificial intelligence into cholangioscopy holds the potential to further refine real-time diagnosis and therapeutic decision-making. As cholangioscopy evolves, its expanding role in the multidisciplinary management of cholangiocarcinoma is reshaping clinical practice. This review highlights its growing impact and explores future directions for research and innovation in biliary disease management.
Core Tip: Cholangiocarcinoma (CCA) remains a major challenge due to its late presentation and limited treatment options. Digital single-operator cholangioscopy has revolutionized the diagnosis and management of CCA by improving diagnostic accuracy through direct visualization, targeted biopsies, and standardized classification systems. It also facilitates therapeutic interventions, including biliary drainage, stenting, and intraductal therapies such as photodynamic therapy and radiofrequency ablation. The integration of artificial intelligence holds promise for further advancements, solidifying cholangioscopy’s role in the multidisciplinary management of CCA.
