Bacteria in the biliary tree have been the bane of surgeons and gastroenterologists alike. On the one hand, up to 50% of patients with chronic cholecystitis have positive bile cultures, as do 75% of patients with acute cholecystitis, and virtually 100% of individuals with cholangitis.^1,2 On the other hand, gut flora are thought to play a key role in the formation of at least black pigment and mixed gall stones, by virtue of mucus production, and the elaboration of B-glucuronidase that deconjugates bilirubin leading to its precipitation with calcium and palmitate.^3–7 Moreover, in the form of a biofilm in which bacteria deposit themselves in complex patterns within a mucopolysaccharide or glycocalyx infrastructure, their presence has been associated with progressive occlusion of implanted medical devices which have a lumen and infections resistant to conventional courses of antibiotics.⁸ Plastic biliary stents, most often placed for malignant obstructive jaundice, have also been noted to occlude by virtue of biofilm development.^9,10 This biofilm appears to be multidimensional and consists of slime, immunoglobulins, and other proteins in conjunction with multiple bacteria species in the setting …