Endoscopic salvage therapy for refractory cystic duct type A bile leak after cholecystectomy with coil-assisted glue embolization: A case report

Figure 1 Imaging results. A: Cystic duct leak with percutaneous drain in gallbladder fossa; B: Biliary cannulation with sphincterotome tip at cystic duct opening; C: SpyGlass cholangioscopy guided cannulation of the cystic duct stump; D: Guidewire placement into the cystic duct via the existing percutaneous drainage catheter; E: Cannula was advanced over the guidewire through the percutaneous drainage tube for selective cystic duct cannulation (panel inset endoscopy showing cannulation); F: Initial deployment of the first embolization coil within the cystic duct stump, viewed under fluoroscopic guidance; G: Fluoroscopic image confirming placement of three embolization coils in the cystic duct stump; H and I: Cholangiogram after coil placement and N-butyl cyanoacrylate glue embolization showing complete occlusion of the cystic duct stump with no residual leak (H: Panel inset- endoscopy showing sphincterotome in ampulla; I: Panel inset - Terumo wire outside ampulla); J: Biliary stent placement across the cystic duct origin following coil embolization; K and L: Follow-up endoscopic retrograde cholangiopancreatography (3 weeks post-procedure) demonstrating no contrast leak from the cystic duct stump.