Biliary surgery has a long history, with biliary strictures being a common clinical issue in this field. These strictures primarily include benign strictures, malignant strictures, and biliary strictures of unknown etiology. The nature of the biliary stricture directly determines the treatment approach. For strictures that are difficult to characterize with CT and MRCP/MRI, endoscopic ultrasound, and related technologies are important tools for the diagnosis and treatment. The rise of technologies such as confocal laser endomicroscopy, optical coherence tomography, and next-generation sequencing has expanded the diagnostic and therapeutic options for biliary strictures. Furthermore, endoscopic surgeons or treatment teams who are proficient in both endoscopic techniques and surgical procedures have unique strengths when dealing with complex anatomical structures or resectable biliary tumors. Although significant advancements have been made in biliary surgery in recent years, particularly in endoscopic technology, surgical techniques, and diagnostic methods, several challenges still remain to be addressed. Here, the authors provide a review of the current status, advancements, and challenges in the endoscopic surgical treatment of biliary strictures, with the aim of offering insights for clinical practice.