This ASG video tip is sponsored by Braintree, maker of the newly approved Souflave and Soutab. So just a few take home points and in terms of approach to indeterminate biliary strictures, I would say two tests are always gonna be better than just one. If you're getting a referral for this patient, I would say definitely do the EUS with ERCP. The EUS is gonna help you pick up those small masses, lymph nodes and liver mats. You can FNA the distal lesions, but don't FNA higher masses or strictures if there's any chance the patient will go for a transplant evaluation. If you're doing an ERCP without local expertise or equipment, then do brush cytology with fluoroscopically guided biopsies. And if you're gonna do ERCP with cholangioscopy, make note of your visual impression and take the directed visual biopsies, especially when you're dealing with higher strictures and consider doing it on the index ERCP to make your diagnosis earlier. Now, if you have negative sampling, but say you had a high suspicion based on your cholangioscopy images, then I would suggest doing a repeat attempt. You can also work up benign causes. And as always, you definitely want to have a multidisciplinary discussion with your surgeons and oncologists when you're dealing with these patients. All right. Thank you.

indeterminate biliary strictures

EUS with ERCP

FNA

Cholangioscopy

collaboration with surgeons and oncologists