Confocal laser endomicroscopy improves diagnosis of cholangiocarcinoma: a case report and review

Cholangiocarcinoma (CCA), a life-threatening malignancy with a poor prognosis, remains diagnostically challenging due to the limited sensitivity and specificity of traditional imaging in differentiating malignant from benign bile duct strictures. This case report and literature review explore the potential of confocal laser endomicroscopy (CLE), an emerging technology for real-time in vivo microscopic imaging, to address this gap. We present the case of a 64-year-old male presenting with scleral icterus, choluria, progressive jaundice, hyperbilirubinemia, and radiologically confirmed biliary dilation. During endoscopic retrograde cholangiopancreatography, CLE revealed intraoperative imaging features suggestive of CCA – a finding subsequently confirmed by postoperative histopathology. Together with supporting literature, this case underscores the clinical utility of CLE by providing high-resolution, real-time visualization of characteristic features, thereby directly aiding in the diagnosis of indeterminate biliary strictures.