Abstract / Summary
Background: Intraductal Papillary Neoplasms of the Bile Duct (IPNB) are rare and diagnostically challenging, particularly in assessing invasiveness and intraductal spread. Cholangioscopy offers promise through direct visualization and targeted biopsies. The aim of this study was to review the current literature on the role of cholangioscopy in diagnosing IPNB, assessment of disease extent and therapeutic applications. Methods: The EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL and Google Scholar databases were systematically searched for articles. Eligible articles investigated cohorts of patients who underwent cholangioscopy for (suspected) IPNB. Results: Seventeen studies comprising 224 patients were included. Despite substantial heterogeneity, cholangioscopy demonstrated high technical success and visualization rates, with a low adverse event rate. Several cholangioscopy-based classification systems describing mucosal and microvascular patterns of IPNB have been proposed, but none are widely adopted. The impact on clinical decision-making was primarily related to confirming tumour invasiveness and assessing preoperative intraductal extent. Two studies showed that cholangioscopy is feasible for therapeutic purposes in IPNB, such as polypectomy and electrocoagulation. Conclusion: Cholangioscopy is increasingly important in the diagnosis and management of IPNB, but standardized visual criteria and consistent biopsy accuracy remain lacking. Therapeutic applications are uncommon yet appear feasible in selected cases. Given the rarity of IPNB, collaborative registries and pooled observational data are needed to support standardized clinical protocols.