Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3669–3671 | Cite as

Letter to Editor on “Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Postcholecystectomy Bile Leak”

  • Massimiliano Mutignani
  • Lorenzo DioscoridiEmail author
  • Francesco Pugliese
  • Marcello Cintolo
  • Angelo Italia
  • Giulia Bonato
  • Aurora Giannetti
  • Edoardo Forti

Dear Editor,

We read with great interest the article by Nezami et al. [1] on the evaluation of the outcomes of selective coil embolization of the cystic duct stump via percutaneously placed drainage catheters in patients with postcholecystectomy bile leaks.

We would like to make few constructive observations on the pathophysiology of these bile leaks related to the described technique.

On the base of our expertise in this field [ 2, 3, 4], we noticed that if the abdominal drain was next to the origin of the leak (the cystic duct stump), it favors the atmospheric-biliary pressure gradient on the biliary-duodenal gradient (even if a complete biliary sphincterotomy is performed) as we explained in our paper [ 2]; for this reason, the bile continues to flow out (Figs.  1, 2). This role of pressure gradients must be always kept in mind. The solution that we proposed, after endoscopic treatment, is to retrieve the abdominal drain 2–3 cm far from the cystic bile leak [ 2].


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

No procedure is preformed, and neither patients’ data are used for this manuscript to require ethical approval.

Informed consent

No patient data are presented in this manuscript to require informed consent.


  1. 1.
    Nezami N, Jarmakani H, Arici M, et al. Selective trans-catheter coil embolization of cystic duct stump in post-cholecystectomy bile leaks. Dig Dis Sci. 2019. Scholar
  2. 2.
    Mutignani M, Forti E, Larghi A, et al. Refractory Bergmann type A bile leak: the need to strike a balance. Endosc Int Open. 2019;7:E264–E267.CrossRefGoogle Scholar
  3. 3.
    Mutignani M, Dioscoridi L, Pugliese F, et al. Primary endotherapy for Strasberg type C bile leaks. Surgery. 2019. Scholar
  4. 4.
    Mutignani M, Forti E, Dokas S, et al. Endotherapy for bile leaks from isolated ducts after hepatic resection: a long awaited challenge. Dig Liver Dis. 2017;49:893–897.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Digestive and Operative Endoscopy UnitNiguarda-Ca’ Granda HospitalMilanItaly

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