Bronchoscopic interventions for bronchopleural fistulas

Abstract

Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development.

A case of attempted transbronchial spigot insertion for fistulous pyothorax in the residual pleural airspace after pleurectomy/decortication for malignant pleural mesothelioma

“…The first step is to attempt to close the bronchopleural fistula (BPF) after treatment of the active infection. BPFs can be closed with endoscopic or surgical procedures, including decortication, direct closure, thoracoplasty, or omental or muscle transposition 4,5 . If closure of the BPF cannot be achieved, open window thoracotomy is considered to evacuate the retained pus.…”

“…Bronchial embolization with an EWS is a first‐line option in conservative management of BPF when the target bronchus is well defined, and its success rate has been reported as 40%–86% 4 . An EWS is a silicone bronchial plug that can be placed in the target bronchus.…”

“…An EWS is a silicone bronchial plug that can be placed in the target bronchus. It is available in three sizes: small, medium and large, with diameters of 5, 6, and 7 mm, respectively, allowing for adaptation to different bronchial diameters 4 . There is a dearth of data on the appropriate duration of EWS insertion, including temporary versus permanent EWS insertion.…”

Inverted Placement of Endoscopic One-Way Endobronchial Valve Combined with Gelfoam in the Closure of Bronchopleural Fistula with Empyema in a Mechanically Ventilated Patient: A Case Report

“…For patients with a high risk for surgery or who need a bridge to surgery, bronchoscopic interventions should be considered. Previous studies showed that the success rate of BPF treated by bronchoscopic techniques ranged from 40% to 100% [ 2 ].…”

Complex bronchopleural fistulas: a case report

“…The mortality rate for BPF after a pneumonectomy can be as high as 16% to 71%. 1,2 The primary clinical symptoms of BPF include fever, chills, purulent cough, chest distress, and dyspnea. If left untreated, BPF can lead to recurrent lung infections, sepsis, respiratory failure, and even death.…”