Endoscopic Treatment of Pancreatic Duct Disruption and Cystic Duct Leak Using Cyanoacrylate: A Case Series

Aims The management of pancreatic duct (PD) disruption and cystic duct leak may represent an endoscopic challenge. In these cases, standard endoscopic therapy involves pancreatic/biliary stenting and sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) [1]. After conservative therapy (fasting, parenteral nutrition, and use of somatostatin analogs) or conventional endoscopic treatments fail, a surgical approach is usually required, leading to a higher mortality due to several technical complications. This study aims to evaluate the effects of N-butyl-2-cyanoacrilate (NBCA), a glue monomer mainly known for its therapeutic role in gastric varices [2], on the endoscopic treatment of PD disruption and cystic duct leak.

Methods A total of six patients underwent endoscopic treatment for post-operative/ traumatic PD disruption (n=3) and post-operative cystic duct leak (n=3) between the months of October 2023 and June 2024. All procedures were conducted by an experienced endoscopist at a tertiary center for biliopancreatic endoscopy.

Results After conservative and standard endoscopic treatment failures, NBCA injection was used to seal the disruption/leak. Therapeutic success, as shown both endoscopically and radiologically, was 100% and no procedural complication was reported.

Conclusions NBCA injection could represent a safe and effective endoscopic option in refractory PD disruption or cystic duct leak. Larger and further studies are necessary to confirm these results.

Publication History

Article published online:
27 March 2025

• References

• 1 Cameron R, Binmoeller KF.. Cyanoacrylate applications in the GI tract. Gastrointest Endosc 2013; 77 (06): 846-857
• 2 Varadarajulu S, Rana SS, Bhasin DK.. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am 2013; 23 (04): 863-892