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World J Gastroenterol. 2011 Sep 7;17(33):3842-9. doi: 10.3748/wjg.v17.i33.3842.

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

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Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China.



To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF).


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.


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).


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.


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

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