| Summary: | Primary sclerosing cholangitis (PSC) is a cholestatic liver disease characterised by chronic
inflammation and fibro-obliteration of the intrahepatic and/or extrahepatic bile ducts. It is
associated with numerous hepatobiliary complications including an increased risk of malignancy (in
particular, cholangiocarcinoma) and biliary tract stone formation. The evaluation of biliary strictures
in patients with PSC is especially challenging, with imaging and endoscopic methods having only
modest sensitivity for the diagnosis of cholangiocarcinoma, and treatment of biliary strictures
poses a similarly significant clinical challenge. In recent years, peroral cholangioscopy has evolved
technologically and increased in popularity as an endoscopic tool that can provide direct intraductal
visualisation and facilitate therapeutic manipulation of the biliary tract. However, the indications for
and effectiveness of its use in patients with PSC remain uncertain, with only a few studies performed
on this small but important subset of patients. In this review, the authors discuss the available data
regarding the use of peroral cholangioscopy in patients with PSC, with a focus on its use in the
evaluation and management of biliary strictures and stones.
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