Percutaneous transhepatic cholangioscopy (PTCS) is an emerging minimally invasive interventional radiology procedure that is used for the diagnosis and management of biliary pathologies. This technique is particularly helpful for patients in whom treatment with endoscopic retrograde cholangiopancreatography and surgery are not available. PTCS is currently used for the management of biliary and gallbladder stones and for the diagnosis and management of benign and malignant strictures. This chapter provides a comprehensive review of the indications and technical details of PTCS, as well as a pictorial display and correlation of cholangiographic and endoscopic findings for various biliary and gallbladder pathologies.