Parekh S, Kamat N, Patra BR, Harindranath S, Pensalwar O, Medabalmewar S, Vora S, Maydeo A. Endoscopic salvage therapy for refractory cystic duct type A bile leak after cholecystectomy with coil-assisted glue embolization: A case report. World J Transl Med 2026; 12(2): 122417 [DOI: 10.5528/wjtm.122417]
Corresponding Author of This Article
Sanil Parekh, Additional Professor, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai 400004, Mahārāshtra, India. sanilparekh.sp@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Parekh S, Kamat N, Patra BR, Harindranath S, Pensalwar O, Medabalmewar S, Vora S, Maydeo A. Endoscopic salvage therapy for refractory cystic duct type A bile leak after cholecystectomy with coil-assisted glue embolization: A case report. World J Transl Med 2026; 12(2): 122417 [DOI: 10.5528/wjtm.122417]
Sanil Parekh, Nagesh Kamat, Biswa Ranjan Patra, Sidharth Harindranath, Onkar Pensalwar, Shivdas Medabalmewar, Sehajad Vora, Amit Maydeo, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai 400004, Mahārāshtra, India
Author contributions: Parekh S, Kamat N, Patra BR, Harindranath S, Pensalwar O, Medabalmewar S, Vora S, and Maydeo A were involved in the preparation of this manuscript; Kamat N wrote the manuscript; Parekh S, Vora S, and Maydeo A were involved in the procedure; Parekh S, Patra BR, Harindranath S, Pensalwar O, Medabalmewar S, and Maydeo A were involved in the clinical management. All authors approved of the final version of the manuscript.
AI contribution statement: The authors state that no AI tools, including large language models (LLMs) or automated writing assistants, were utilized at any stage of this research. The authors take full responsibility and accountability for all content of this manuscript. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Sanil Parekh, Additional Professor, Institute of Gastrosciences, Sir H. N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai 400004, Mahārāshtra, India. sanilparekh.sp@gmail.com
Received: April 21, 2026 Revised: May 21, 2026 Accepted: June 24, 2026 Published online: July 28, 2026 Processing time: 102 Days and 15.2 Hours
Abstract
BACKGROUND
An 83-year-old male with multiple comorbidities presented with high-output biliary leak following a subtotal cholecystectomy for acute cholecystitis. He was referred for advanced biliary intervention.
CASE SUMMARY
Despite repeated endoscopic retrograde cholangiopancreatography and the placement of up to three biliary plastic stents, the patient experienced an increase in bilious drainage reaching 200 mL/day, accompanied by significant weight loss. Magnetic resonance cholangiopancreatography revealed a fluid collection at the gallbladder bed connected to the biliary tree, confirming an active bile leak, likely originating from the cystic duct stump. At endoscopic retrograde cholangiopancreatography, the previously placed biliary stents were removed, and common bile duct (CBD) was selectively cannulated. Cholangiogram showed dilated CBD with a leak at the cystic duct. SpyGlass cholangioscope was used to cannulate the cystic duct, and a guidewire was passed through the leak site to the percutaneous drain. A biliary access cannula was inserted over the guidewire via the percutaneous route, and 3 coils (two of 4 mm and one of 6 mm) were deployed at the leak site, followed by cyanoacrylate glue injection. This achieved immediate and complete cessation of the leak, as confirmed by an occlusion cholangiogram. A 7-Fr 12-cm plastic biliary stent was placed into the CBD, and free flow of bile was noted, providing a minimally invasive solution for a refractory post-surgical complication.
CONCLUSION
This case highlights that for persistent, high-output stump leaks that fail conventional stenting, the combined use of cholangioscopy-guided coil and glue embolization offers an effective salvage therapy that avoids the morbidity of a second major surgery.
Core Tip: Persistent high-output cystic duct stump leaks that fail conventional endoscopic stenting pose a significant therapeutic challenge, particularly in elderly patients with multiple comorbidities. For refractory biliary leaks, Spyglass cholangioscopy and percutaneous access enable precise targeting of the leak site. Utilizing a combination of coils and cyanoacrylate glue can achieve complete cessation of high-output drainage when multiple plastic stents have failed, offering a successful solution within the biliary tree and an alternative to high-risk revisional surgery.
