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Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years

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Author(s): Guan-Qun Liao | Hao Wang | Guang-Yong Zhu | Kai-Bin Zhu | Fu-Xin Lv | Sheng Tai

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 17;
Issue: 33;
Start page: 3842;
Date: 2011;
Original page

Keywords: Bronchobiliary fistula | Digestive endoscopy | Endoscopic retrograde cholangio-pancreatography | Magnetic resonance cholangio | Percutaneous transhepatic cholangio | Iatrogenic damage | Congenital diaphragma defects | Hepatobiliary imino-diacetic acid scan

ABSTRACT
AIM: To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF). METHODS: Literature searches were performed in Medline, EMBASE, PHMC and LWW (January 1980-August 2010) using the following keywords: biliobronchial fistula, bronchobiliary fistula, broncho-biliary fistula, biliary-bronchial fistula, tracheobiliary fistula, hepatobronchial fistula, bronchopleural fistula, and biliptysis. Further articles were identified through cross-referencing. RESULTS: Sixty-eight cases were collected and reviewed. BBF secondary to tumors (32.3%, 22/68), including primary tumors (19.1%, 13/68) and hepatic metastases (13.2%, 9/68), shared the largest proportion of all cases. Biliptysis was found in all patients, and other symptoms were respiratory symptoms, such as irritating cough, fever (36/68) and jaundice (20/68). Half of the patients were treated by less-invasive methods such as endoscopic retrograde biliary drainage. Invasive approaches like surgery were used less frequently (41.7%, 28/67). The outcome was good at the end of the follow-up period in 28 cases (range, 2 wk to 72 mo), and the recovery rate was 87.7% (57/65). CONCLUSION: The clinical diagnosis of BBF can be established by sputum analysis. Careful assessment of this condition is needed before therapeutic procedure. Invasive approaches should be considered only when non-invasive methods failed.
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