Endoscopic ultrasound (EUS) significantly influences surgical decisions in cholangiocarcinoma by identifying new findings, leading to 10% of patients being excluded from curative-intent surgery.

• Overall, EUS findings excluded patients from surgery 10% of the time, with 7% for perihilar cholangiocarcinoma.
• The incremental benefit of EUS over traditional imaging revealed a further 3% of patients with malignant lymph nodes not seen on standard imaging.

Surgeons should consider EUS for better staging accuracy to refine patient selection for surgery or transplantation.