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

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


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.

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

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biliary Fistula / diagnosis
  • Biliary Fistula / etiology
  • Biliary Fistula / pathology
  • Biliary Fistula / therapy*
  • Bronchial Fistula / diagnosis
  • Bronchial Fistula / etiology
  • Bronchial Fistula / pathology
  • Bronchial Fistula / therapy*
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome
  • Young Adult