Ulcerative colitis is associated with primary sclerosing cholangitis. Which diagnostic procedure is commonly used to evaluate biliary disease in this context?

• A. Abdominal ultrasound
• B. MRCP
• C. Colonoscopy
• D. Endoscopic cholangiography

Answer: (D)

In this scenario, the biliary tract needs direct imaging and often tissue assessment to evaluate PSC in the setting of ulcerative colitis. Endoscopic cholangiography, performed via ERCP, provides a direct view of the bile ducts (showing the characteristic beading and multifocal strictures) and allows sampling of ductal tissue with brushings or biopsies to look for cholangiocarcinoma. It also enables therapeutic options such as dilating dominant strictures or placing stents if needed. While MRCP is a noninvasive way to visualize the biliary tree, ERCP offers both diagnostic detail and immediate management when biliary disease is suspected or needs intervention, which is why it is commonly used in this context.