Commentary.

Abstract

Refractory bronchobiliary fistula (BBF) is a rare complication that frequently poses a significant therapeutic challenge. Given the high morbidity and mortality associated with surgical fistulectomy, conservative interventions are still preferred. In this video, Didden et al. demonstrate the treatment of a refractory bronchobiliary fistula via endoscopic retrograde cholangiography, with the use of both embolization coils and glue. Previous reports have described the successful use of endoscopic or percutaneous embolization with glue and coil for refractory bile leak, with a clinical success rate of 78 % to 100 % [1] [2] [3]. In this case, the authors used Histoacryl (n-butyl-2-cyanoacrylate) glue, which offers a more rapid polymerization time in comparison to alternatives such as Dermabond (2-octyl-2-cyanoacrylate), thereby lowering the risk of glue migration outside the fistula [4]. The authors also used a straight cannulation to inject the glue. However, an extraction balloon catheter that can occlude the bile duct during injection may better prevent glue migration outside the fistula. Ultimately, minimally invasive alternatives to the management of BBF, such as described here, offer promising benefits to patients in whom first-line management has failed and further investigation is warranted.