Cholangioscopy is an important component of the management of a selected group of patients with biliary diseases. Due to the advantage of direct visualization cholangioscopy provides targeted diagnostic and therapeutic procedures under endoscopic control. Thus cholangioscopy improves the differentiation of benign and malignant intraductal lesions, targeted biopsies and precise delineation of intraductal tumor spread before surgical resection. Furthermore lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be carried out under endoscopic control. Recent developments of new types of conventional peroral cholangioscopy permit feasible, safe and effective procedures that can broaden the use of this technique at reasonable costs. Hence the spectrum of diagnostic and therapeutic interventions under cholangioscopic control will be further expanded in the future.