Cholangiocarcinoma (CCA) is a devastating malignancy with high mortality, in part due to the combination of late presentation, significant diagnostic challenges and limited effective treatment options. Late presentation and diagnosis contribute to the high mortality in CCA and there is an urgent unmet need for diagnostic and prognostic biomarkers to facilitate early diagnosis and treatment stratification to improve clinical outcomes. MiRs are small ncRNA molecules that regulate gene expression and modulate both tumor suppressive and oncogenic pathways. They have a well-defined role in carcinogenesis, including CCA. In this review, we outline the evidence for MiRs in the pathogenesis of CCA and their potential utility as diagnostic and prognostic biomarkers to guide clinical management.