Percutaneous intrabiliary injection of gelatin sponge slurry for the management of acute hemobilia during biliary interventions: an alternative salvage technique

PURPOSE: To evaluate percutaneous intrabiliary injection of gelatin sponge (Gelfoam) slurry as a preliminary salvage technique for acute hemobilia during biliary interventions when angiographic embolization is unavailable. MATERIAL AND METHODS: We retrospectively reviewed eight patients with significant hemobilia during percutaneous biliary procedures between September 2024 and December 2025. Notably, seven patients (87.5%) had pre-existing clinical cholangitis that was controlled with therapeutic antibiotics prior to the bleeding event. Gelfoam slurry was injected directly into the biliary tree or tract to achieve hemostasis via internal compression and the promotion of localized thrombosis, while maintaining post-procedural catheter drainage and continued antibiotic coverage. RESULTS: Immediate technical hemostasis was achieved in all cases (100%). One instance of recurrent bleeding at 10 days was successfully managed with a repeat injection. Post-procedural infectious episodes (fever, leukocytosis) were observed in two patients (25%), requiring an upgrade in targeted antibiotic therapy. The pre-existing infectious baseline in the majority of the cohort complicates the distinction between recurrent cholangitis and de novo foreign-body-related infection. CONCLUSION: Preliminary experience suggests that intrabiliary Gelfoam slurry may represent a potential bridging or salvage maneuver for acute hemobilia in resource-constrained scenarios. However, because it relies on internal compression rather than definitive vascular repair, and carries potential risks of infectious exacerbation, it should be applied cautiously with strict follow-up and does not replace definitive transcatheter arterial embolization.