{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T16:07:16Z","timestamp":1772726836414,"version":"3.50.1"},"reference-count":10,"publisher":"SMC Media","issue":"3","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>ntroduction:\u00a0A bronchobiliary fistula (BBF) is a rare pathological communication between the biliary tract and the bronchial tree. It is most often associated with hepatic tumours, infections or trauma. The diagnosis can be challenging; management strategies vary and include conservative, surgical and endoscopic approaches. Case description:\u00a0A 61-year-old woman with metastatic colorectal cancer to the liver \u2013managed with hepatic resections and ablation \u2013 presented with progressive dyspnoea and a productive cough. She had a recent history of pyogenic liver abscess treated with antibiotics. A computed tomography (CT) scan revealed a persistent hepatic abscess with a fistulous tract to the right middle lobe. Bronchoscopy confirmed bilious secretions from the right middle lobe. Initial management with endobronchial BioGlue application resulted in temporary improvement; however, recurrence occurred within eight days. A bronchoscopy was then repeated with additional BioGlue applied, and a 5.5 Zephyr endobronchial valve was deployed into the right middle lobe. The proximal orifice of the valve was sealed with BioGlue to ensure occlusion. This combined approach resulted in improved oxygenation and cessation of air leak from the biliary drain. Despite successful fistula closure, the patient succumbed to candida fungemia. Conclusion:\u00a0BBF remains a challenging condition with no standardised management guidelines. This case represents the first reported use of BioGlue\u00ae\u00a0in combination with a Zephyr\u00ae\u00a0endobronchial valve for successful endobronchial closure of a bronchobiliary fistula. Our experience highlights the potential of innovative bronchoscopy interventions as minimally invasive alternatives to surgery in select patients.<\/jats:p>","DOI":"10.12890\/2026_005801","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:25:24Z","timestamp":1772209524000},"source":"Crossref","is-referenced-by-count":0,"title":["The use of bovine serum albumin and Zephyr endobronchial valves for managing a bronchial-biliary fistula: a novel approach"],"prefix":"10.12890","volume":"13","author":[{"given":"Hussein","family":"Rabah","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care, Oklahoma University, Oklahoma City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Houssein","family":"Youness","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care, Oklahoma University, Oklahoma City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Awais","family":"Bajwa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care, Oklahoma University, Oklahoma City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fawad","family":"Chaudry","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care, Oklahoma University, Oklahoma City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"10.12890\/2026_005801_ref1","unstructured":"Peacock, TB. Case in which hydatids were expectorated, and one of suppuration in a hydatid cyst of the liver communicating with the lungs. Edinb Med Surg J 1850;74:33\u201346. Erratum in: Edinb Med Surg J 1850;74:ii."},{"key":"10.12890\/2026_005801_ref2","doi-asserted-by":"crossref","unstructured":"Liao GQ, Wang H, Zhu GY, Zhu KB, Lv FX, Tai S. Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years. World J Gastroenterol 2011;17:3842-3849. doi: 10.3748\/wjg.v17.i33.3842","DOI":"10.3748\/wjg.v17.i33.3842"},{"key":"10.12890\/2026_005801_ref3","doi-asserted-by":"crossref","unstructured":"D\u2019Ovidio F, Mura M, Tsang M, Waddell TK, Hutcheon MA, Singer LG, et al. Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thorac Cardiovasc Surg 2005;129:1144\u20131152. doi: 10.1016\/j.jtcvs.2004.10.035","DOI":"10.1016\/j.jtcvs.2004.10.035"},{"key":"10.12890\/2026_005801_ref4","doi-asserted-by":"crossref","unstructured":"Acquasanta M, Spadarella G, Civelli EM. Spontaneous bronchobiliary fistula: case report. J Radiol Case Rep 2020;14:10\u201315. doi: 10.3941\/jrcr.v14i10.3743","DOI":"10.3941\/jrcr.v14i10.3743"},{"key":"10.12890\/2026_005801_ref5","doi-asserted-by":"crossref","unstructured":"Annovazzi A, Viceconte G, Romano L, Sciuto R, Maini CL. Detection of a suspected bronchobiliary fistula by hepatobiliary scintigraphy. Ann Nucl Med 2008;22:641\u2013643. doi: 10.1007\/s12149-008-0154-z","DOI":"10.1007\/s12149-008-0154-z"},{"key":"10.12890\/2026_005801_ref6","doi-asserted-by":"crossref","unstructured":"Kim JH, Kim MD, Lee YK, Hwang SG, Lee JH, Kim EK, et al. Bronchobiliary fistula treated with histoacryl embolization under bronchoscopic guidance: a case report. Respir Med CME 2008;1:164\u2013168.doi: 10.1016\/j.rmedc.2008.04.002","DOI":"10.1016\/j.rmedc.2008.04.002"},{"key":"10.12890\/2026_005801_ref7","doi-asserted-by":"crossref","unstructured":"Goldman SY, Greben CR, Setton A, McKinley MJ, Axelrod DJ, Charles HW, et al. Bronchobiliary fistula successfully treated with n-butyl cyanoacrylate via a bronchial approach. J Vasc Interv Radiol 2007;18:151\u2013155. doi: 10.1016\/j.jvir.2006.10.012","DOI":"10.1016\/j.jvir.2006.10.012"},{"key":"10.12890\/2026_005801_ref8","doi-asserted-by":"crossref","unstructured":"Freidkin L, Azem K, Pertzov B, Izhakian S, Rosengarten D, Kramer MR. Endobronchial closure of broncho-biliary fistula using Amplatzer device: case report. Respir Med Case Rep 2023;46:101943. doi: 10.1016\/j.rmcr.2023.101943","DOI":"10.1016\/j.rmcr.2023.101943"},{"key":"10.12890\/2026_005801_ref9","unstructured":"U.S. Food and Drug Administration. Summary of Safety and Effectiveness CryoLife, Inc., BioGlue\u00ae Surgical Adhesive [Internet]. [cited 2025, Apr 2]. Available from: https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf\/p010003b.pdf"},{"key":"10.12890\/2026_005801_ref10","unstructured":"U.S Food and Drug Administration:, Premarket approval of the Zephyr Endobronchial Valve System,[Internet]. 2018. 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