{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:15:07Z","timestamp":1760058907984,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The management of refractory pancreatic duct (PD) and cystic duct leaks may represent an endoscopic challenge. Standard endoscopic therapy involves pancreatic\/biliary sphincterotomy and stenting during endoscopic retrograde cholangiopancreatography (ERCP). After conservative (fasting, parenteral nutrition, and use of somatostatin analogs) or conventional endoscopic treatments fail, a surgical approach is usually required, leading to higher mortality due to several technical complications. Previous evidence of the endoscopic use of N-butyl-2-cyanoacylate (NBCA) for treating pancreaticobiliary leaks is reported, although the evidence is scarce. Methods: Six patients with pancreaticobiliary leaks (three IT pancreatic leaks and three Class A sec. Strasberg post-cholecystectomy biliary leaks) refractory to previous treatment were treated with the endoscopic topical application of NBCA. All our patients gave informed consent. The procedures were all performed between December 2017 and February 2025 at a tertiary referral center for biliopancreatic endoscopy. Results: Therapeutic success, as shown both endoscopically and radiologically, was 100%, and no procedural complication was reported. In one patient with biliary leak, standard cannulation of the cystic duct stump with the guidewire was unsuccessful, requiring a peroral cholangioscopy (SpyGlass System DSII) to directly visualize the leakage site, allowing a precise closure of the wall defect with NBCA. Conclusions: NBCA injection could represent a safe and effective endoscopic option in refractory PD of the tail of the pancreas and cystic duct leaks. Larger and further studies are necessary to confirm these results.<\/jats:p>","DOI":"10.3390\/jcm14103362","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T09:13:38Z","timestamp":1747041218000},"page":"3362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Use of N-Butyl-2-Cyanoacrylate in Refractory Pancreatic Duct Leak and Cystic Duct Leak: Is It Really a Last Resort?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5213-3193","authenticated-orcid":false,"given":"Mario","family":"Gagliardi","sequence":"first","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6969-6949","authenticated-orcid":false,"given":"Carlo","family":"Soldaini","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno, 84084 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariano","family":"Sica","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8793-4583","authenticated-orcid":false,"given":"Carmela","family":"Abbatiello","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Fusco","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Fimiano","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppina","family":"Pontillo","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-3873","authenticated-orcid":false,"given":"Elio","family":"Donnarumma","sequence":"additional","affiliation":[{"name":"A.O.U. San Giovanni di Dio e Ruggi d\u2019Aragona, U.O.C. Clinica Chirurgica e Trapianti di Rene, 35128 Padova, Italy"},{"name":"Department of Surgery and Transplants, AOU San Giovanni di Dio and Ruggi d\u2019Aragona, University of Salerno, 84084 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-7386","authenticated-orcid":false,"given":"Alessandro","family":"Puzziello","sequence":"additional","affiliation":[{"name":"A.O.U. San Giovanni di Dio e Ruggi d\u2019Aragona, U.O.C. Clinica Chirurgica e Trapianti di Rene, 35128 Padova, Italy"},{"name":"Department of Surgery and Transplants, AOU San Giovanni di Dio and Ruggi d\u2019Aragona, University of Salerno, 84084 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Zulli","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d\u2019Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino, 84131 Salerno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1055\/a-1939-4887","article-title":"Endoscopic Diagnosis and Management of Esophagogastric Variceal Hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Gralnek","year":"2022","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.gie.2013.01.028","article-title":"Cyanoacrylate Applications in the GI Tract","volume":"77","author":"Cameron","year":"2013","journal-title":"Gastrointest. 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