based on biliary brushing may be beneficial. However, which method is the best choice for the diagnosis of MBSs should be further explored. For brushing, we still need to know whether 30 passes are enough or a novel type of brush can change the dilemma. Therefore, more clinical trials are required to elucidate these issues. We once again thank Drs. Angadi and Giri who raised their important concerns and hope the unmet needs for the diagnosis of MBSs could be solved in the near future.