N-Butyl Cyanoacrylate (NBCA)-Based Repair of Iatrogenic Common Bile Duct Focal Injury

Purpose: Common bile duct injury and bile leak have remained the same over the last decade despite significant improvement in the procedures. The aim of this study was to assess the efficacy of transcatheter n-butyl cyanoacrylate (NBCA) in the repair of bile ducts injury in patients with persistent postsurgical bile leaks.

Methods: Repair of bile ducts with NBCA was performed in eight patients (two men and six women). First, access to the biliary system was secured and a cholangiogram was performed. Also, injection to the bile collection was done to show the leak. A glue solution made of a combination of NBCA glue, lipiodol, and tantalum powder was delivered to the target through a catheter which was irrigated with dextrose solution. Internal–external biliary drainage catheter was temporary placed in all cases.

Results: Five patients were presented after cholecystectomy, two patients after hepatic lobectomy, and one patient post-endoscopic retrograde cholangiopancreatography. All patients had focal or partial injury to the common bile duct. All patients were treated successfully on the first attempt. Bile leak was immediately resolved in all patients on follow-up cholangiogram. The average length of follow-up was 19 months. Although reported in prior reports, there was no spillage of glue into the common bile duct (CBD). In one patient, glue immigrated into the distal common bile duct, causing common bile duct obstruction signs and symptoms following internal/external biliary drainage catheter removal. Therefore, the CBD was accessed through the drainage catheter tract and the dislodged glue was pushed into the duodenum using a balloon catheter.

Conclusions: Repair of common bile duct with NBCA glue is a safe procedure with excellent results in patients with focal/partial injury of the common bile duct.