Comparison Bile Duct Brushings, Cholangioscopy-Directed Biopsies and Pediatric Forceps Biopsies in Biliary Strictures

Inclusion Criteria: 1. All patients with obstructive jaundice, and imaging (CT or MRI) suggestive of biliary stricture, without obvious pancreatic mass 2. All patients with obstructive jaundice, and index ERCP suggestive of biliary stricture, without obvious pancreatic mass 3. All patients with obstructive jaundice, and prior ERCP suggestive of biliary stricture 4. Expected patient survival of at least 90 days 5. High likelihood of patient follow-up 6. Patient is able to give a written informed consent 7. Patient is willing and able to comply with the study procedures Exclusion Criteria: 1. Patients with imaging suggestive of pancreatic tumor 2. Children \< 18 years of age 3. Pregnant women 4. Patients with impaired decision-making 5. Healthy volunteers 6. Primary Sclerosing Cholangitis (PSC) 7. Patients with untreated coagulopathy at the time of procedure or ongoing need for anti-coagulation 8. Patients with any contraindication to endoscopic procedure 9. Participation in another investigational study that may directly or indirectly affect the results of this study within 30 days prior to the initial visit 10. Patients unable to provide informed consent