Endobronchial embolization for life-threatening hemoptysis with Endobronchial Watanabe Spigot

Abstract

BackgroundMassive hemoptysis is a common encounter in respiratory medicine. Bronchoscopy plays an important role in localizing the origin of bleeding, as well as endoscopic treatment of centrally located lesions. Endobronchial embolization is a novel technique enabling the management of hemoptysis arising even from peripheral lesions, via occlusion of the culprit bronchus, thereby securing the airway. Endobronchial Watanabe Spigot had been advocate in the treatment of bronchopleural fistula and the use of this novel technique had since then been expanded into the management of massive hemoptysis. To the best of our knowledge, this is the first reported case in Malaysia.Case presentation78-year-old lady who presented with life-threatening hemoptysis leading rapidly to cardiac arrest upon arrival. Spontaneous circulation was restored after resuscitation with an urgent thoracic computed tomography angiogram revealed bleeding likely from the posterior basal segment of left lower lobe, with bronchiectatic changes. Urgent flexible bronchoscopy revealed airway flooding, with bleeding originating from the lingular and posterior-basal segment of the left lower lobe. Airway toileting was performed and two 7 mm Endobronchial Watanabe Spigots were plugged into the culprit bronchi. Urgent bronchial artery embolization was then attempted, but was unsuccessful. She was managed conservatively, as surgical resection was deemed high risk. The spigots were removed 4 days later uneventfully. There was no recurrence of hemoptysis, and patient remained well during 1-month follow up.ConclusionsThe utmost priority in managing life-threatening hemoptysis is to prevent airway flooding. Endobronchial embolization with Endobronchial Watanabe Spigot is useful as a temporary measure before definitive therapy, or can itself be the main therapeutic player in the hemoptysis armament for high-risk patients.

Aetiology, diagnosis and treatment of moderate-to-severe haemoptysis in a North American academic centre

“…Bronchoscopy under general anaesthesia may be necessary when high volume active bleeding and hypoxaemia are concerns. Rigid bronchoscopy can be useful in this population by stabilising the airway, providing the possibility to use large bore suction and allowing endoscopic interventions such as the use of laser or argon and the positioning of oxidised regenerated cellulose [ 21 ], biocompatible glue [ 24 ], endobronchial stents [ 25 ] or silicone spigots [ 26 , 27 ].…”

Competence in pulmonary endoscopy emergencies

“…Silicone spigots, originally used in the treatment of bronchopleural fistula, have proved to be effective for temporary control of bleeding from segmental bronchi, allowing patients to stabilize before Bae. 53 When all the above devices are unable to stop bleeding, isolation of the healthy lung is the last chance. it can be achieved by selective intubation with a double-lumen endotracheal tube (carlens e robershow); the main disadvantage is technical difficulty in properly positioning.…”

Successful Long-term Management of Two Cases of Moderate Hemoptysis Due to Chronic Cavitary Pulmonary Aspergillosis with Bronchial Occlusion Using Silicone Spigots

“…Bronchial occlusion using EWS is performed to control any hemorrhaging from peripheral lung lesions. The data and clinical findings of previous reports and the present two cases of hemoptysis treated with bronchial occlusion using EWS are described in Table ( 7 - 12 ). In 2006, Dutau et al first reported a case of massive hemoptysis due to idiopathic bronchial hemorrhaging that was successfully treated with bronchial occlusion using EWS ( 7 ).…”

“…Bronchial occlusion using EWS can be applied for persistent air leaks in pneumothorax, postoperative or traumatic lung fistula, empyema with fistula, and fistula with other organs ( 6 ). Recently, the efficacy of bronchial occlusion using EWS for hemostasis has been reported ( 7 - 12 ). This procedure is usually performed for temporary hemostasis in conjunction with additional treatment methods, such as surgery and bronchial pulmonary embolization (BAE); however, both the long-term efficacy and safety of this method remain unclear.…”