Indeterminate biliary strictures refer to biliary strictures without an identifiable cause on imaging. The endoscopist's role is to determine if the stricture is benign or malignant and offer treatment options. Available tools for evaluation include ERCP, cholangioscopy, intraductal ultrasound (IDUS), and endoscopic ultrasound (EUS). ERCP allows for tissue sampling but has a sensitivity of only 30-55%. Newer techniques like fluorescence in-situ hybridization and confocal endomicroscopy can increase sensitivity. Direct visualization with cholangioscopy may improve detection over standard ERCP. IDUS provides high accuracy in differentiating benign from malignant strictures without direct sampling. EUS allows for