Bronchobiliary fistulae are often related to hepatic tumors and also occur after ablative
therapy [1]
[2]. Endoscopic sphincterotomy or stenting is considered first-line treatment. In case
of refractory fistulas, sealing with glue or coils has been suggested, however data
are scarce [3]
[4].
We present a 53-year-old woman who underwent locoregional treatments of colorectal
liver metastasis, including segment 2/3 and wedge resections, radiofrequency ablation
(segment 8), and radio-embolization. Plastic stents (after sphincterotomy) were previously
inserted to treat sclerosis of both hepatic ducts related to intra-arterial chemotherapy.
She was referred for endoscopic management of a refractory bronchobiliary fistula,
resulting in bilioptysis.
Endoscopic retrograde cholangiography (ERC) confirmed leakage from a peripheral bile
duct in segment 8 towards the bronchial tree ([Video 1], [Fig. 1]). A 4-Fr tapered Glo-tip catheter (Cook Medical, Bloomington, Indiana, USA) was
advanced just underneath the fistula. Two coils (Tornado 0.035 inch, 4–3 mm, and MRey
0.035 inch, 5 mm; Cook Medical) were deployed at the fistula by pushing them through
and out the catheter with a standard 0.035-inch guidewire. Two plastic stents were
re-inserted over the persistent hepatic duct strictures.
Video 1 Sealing of a bronchobiliary fistula by endoscopic retrograde cholangiography using
coils and Histoacryl.
Fig. 1 Cholangiography demonstrating bronchobiliary fistula.
After initial resolution, bilioptysis recurred after two weeks and a second ERC was
performed showing persistent leakage alongside the coils. A cannula (Tandem XL; Boston
Scientific, Marlborough, Massachusetts, USA) was advanced and was flushed with a 5 %
glucose solution. N-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany)
was diluted with Lipiodol (Guerbet GmbH, Sulzbach, Germany) (0.5 ml: 0.5 ml). The
glue mixture was injected slowly by pushing it with a 5 % glucose solution. The catheter
was pulled back under fluoroscopic guidance during injection. An elongated glue cast
was seen after injection of 0.3 cc around the coils and in the end of the peripheral
bile duct. Two plastic stents were repositioned ([Fig. 2]). No complications occurred and the patient remained symptom-free during 2 months’
follow-up.
Fig. 2 Presence of two coils (blue arrow) and glue cast (red arrow) at the fistula and in
the small peripheral bile duct.
Endoscopy_UCTN_Code_TTT_1AR_2AG
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online. Processing charges apply (currently EUR
375), discounts and wavers acc. to HINARI are available.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
Citation Format
Endoscopy 2023; 55 (S01); E268–E269. doi: 10.1055/a-1974–9202.
