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Objective: To evaluate the feasibility and diagnostic value of percutaneous transhepatic cholangioscopy biopsy (PTCB) for identifying the causes of biliary strictures., Methods: This retrospective study included 34 patients (18 females and 16 males), with a mean age of 59.4 ± 13 years. The study population consisted of patients with suspected malignant biliary strictures on imaging or biliary lesions suspected of malignancy during percutaneous transhepatic endoscopic biliary lithotripsy (PTEBL). The final diagnosis for each patient was confirmed based on surgical pathology results, additional histopathological data, or through close clinical and imaging follow-up for at least one year., Results: Among the patients, 20 (58.9%) underwent PTCB alone, while 14 (41.1%) underwent PTCB combined with PTEBL. Biopsy locations included: 12 patients (35.3%) with intrahepatic bile duct, 12 patients (35.3%) with hilar bile duct, and 10 patients (29.4%) with common bile duct. Technical success of PTCB was defined as successful access to the biliary lesion, with the collection of an adequate histopathological tissue sample achieved in 100% of patients. The sensitivity, specificity, and accuracy of PTCB were 90%, 100%, and 97.1%, respectively. Minor complications were observed in 3 patients (8.8%)., Conclusion: PTCB is a feasible and effective method for diagnosing the causes of biliary strictures, offering high sensitivity, specificity, and accuracy., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for Publication: For this type of study consent for publication is not required. Informed Consent: This study has obtained IRB approval from Hanoi Medical University (4540 QĐ-ĐHYHN) and the need for informed consent was waived., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)