Endoscopic intrabiliary placement of a fibrin plug for the treatment of traumatic bile duct injuries

A variety of traumatic and iatrogenic injuries can lead to bile duct leaks or fistula. These leaks are commonly managed by transpapillary biliary stent placement, which reduces in traductal pressure and facilitates closures. A small percentage of these lesions are resistant to this technique, however. We propose a novel endoscopic approach for traumatic bile duct injuries that uses commercially available cryoprecipitate/thrombin, simultaneously administered during endoscopic retrograde cholangiopancreatography [ERCP], creating a fibrin "plug" within the region of leakage. Two cases are presented that detail our experiences