Endobronchial valves for bronchopleural fistula: pitfalls and principles

Gaspard, Dany; Bartter, Thaddeus; Boujaoude, Ziad; Raja, Haroon; Arya, Rohan; Meena, Nikhil; Abouzgheib, Wissam

doi:10.1177/1753465816672132

Cited by 20 publications

(19 citation statements)

References 10 publications

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“…Development of new and efficient techniques and devices may further help to heal or completely seal TGAF. 24,25…”

Section: Discussionmentioning

confidence: 99%

Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing

Wang¹,

Tao²,

Zhang³

et al. 2019

Ther Adv Respir Dis

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Background: Thoracogastric-airway fistula (TGAF) post-thoracic surgery is a rare and challenging complication for esophagectomy. The aim of this study was to explore the effectiveness of airway stenting for TGAF patients and find related factors coupled with healing of fistula. Methods: This is a retrospective study involving patients with TGAF who were treated with airway stentings. Based on different TGAF locations and sizes on chest computed tomography, covered metallic or silicon airway stents were implanted to cover orifices under interventional bronchoscopy. TGAF healing was defined as the primary outcome, and complete sealing of TGAF as the second outcome. The predictors for TGAF healing were analyzed in univariate and multivariate analysis. Results: A total of 58 TGAF patients were included, of whom 7 received straight covered metallic stents, 5 straight silicon stents, 3 L-shaped covered metallic stents, 21 large Y-shaped covered metallic stents, 17 large Y-shaped silicon stents, and 5 with Y-shaped covered metallic stents. Healing was achieved in 20 (34.5%) patients, and complete sealing in 45 (77.6%) patients. There were no significant differences in healing rate and complete sealing rate between patients receiving metallic stents and those with silicon stents. In univariate analysis, lacking a previous history of radiotherapy or chemotherapy, nonmalignant fistulas, small fistulas, and shorter postesophagectomy duration were found associated with a higher rate of TGAF healing. Only shorter postesophagectomy duration was associated with TGAF healing in multivariate analysis. Conclusions: Both silicon and covered metallic airway stenting are effective methods to close TGAF. A shorter postesophagectomy period may predict better TGAF healing. The reviews of this paper are available via the supplemental material section.

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“…Development of new and efficient techniques and devices may further help to heal or completely seal TGAF. 24,25…”

Section: Discussionmentioning

confidence: 99%

Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing

Wang¹,

Tao²,

Zhang³

et al. 2019

Ther Adv Respir Dis

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“…EBVs, which were originally developed for the endoscopic reduction of lung volume in emphysema, and offering a non-surgical minimally-invasive alternative, have been available since 2003 [6]. The first attempt to use EBVs for the treatment of BPF was in 2005, leading to approval as a humanitarian-use device for the treatment of BPF in 2006 [7]. EBVs are introduced through the working channel of a flexible bronchoscope utilizing a unidirectional valve to prevent airflow into the diseased area of the lung resulting in the collapse of the distal lung parenchyma and attenuation of an air leak [8].…”

Section: Discussionmentioning

confidence: 99%

Surgically intractable bronchopleural fistula treated with endobronchial valve insertion by isolating the tract with indigo carmine: A case report

Song

Kim

et al. 2020

Respiratory Medicine Case Reports

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Bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. Herein, we report a patient with persistent air leak after necrotizing pneumonia, where tract of BPF was not apparent in computed tomography (CT). Despite control of infection, watchful observation, repetitive procedures, and surgery, air leak was not resolved. This led to consideration of the endobronchial valve (EBV) placement. After identifying the bronchial segment leading to the fistula with indigo carmine, precise occlusion of the lingular division of the left upper lobe (LUL) was performed using an EBV. Subsequently, the air leak was resolved. During 6 months of follow-up, neither recurrence of BPF nor any procedure-related complications were noted. We concluded that precise EBV placement by identifying bronchial segment leading to the BPF, could be an effective treatment for persistent air leak.

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“…Bronchoscopic treatment with various techniques to close smaller fistulae <8 mm have been described (76) with the potential advantages of avoidance of operation and lower cost (60,61). Numerous agents have been employed including tissue glues (77)(78)(79)(80), metallic coils (81,82), stents (83)(84)(85)(86)(87), endobronchial one-way valves (88)(89)(90)(91) and the Watanabe Spigot (92), expandable resorbable sponges, patches or mesh (93)(94)(95) or submucosal sclerosant injection (96) with success rates ranging from 33% to 100%. Caution as to the added efficacy of these techniques is advised however when noting a study comparing conservative treatment and conservative plus endoscopic treatment, which found no significant difference in the mean time to resolution of BPF between the two groups (97).…”

Section: Bronchopleural Fistulamentioning

confidence: 99%

Post-lobectomy airways complications

Wallwork¹,

Belcher²

2021

Shanghai Chest

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Post-lobectomy airways complications are associated with significant morbidity and mortality.Lobar torsion, bronchopleural fistula and bronchovascular fistula pose a challenge to the clinician to secure timely diagnosis and intervention in order to improve outcomes. We discuss the aetiology, presentation, prevention and management of lobar torsion, bronchopleural and bronchovascular fistula and anastomotic complications following lobar resection. Judicious surgical technique and effective employment of preventative strategies may reduce the risk of airway complications. Presentation of post-lobectomy airway complications may be non-specific but are often rapidly progressive. Computed tomography (CT) and bronchoscopy are essential diagnostic tools to support clinical suspicion. The pillars of successful management of post-lobectomy airway complications are a high degree of clinical suspicion, prompt investigation and early intervention. These are essential to minimise perioperative mortality and long-term sequelae. Minimal access surgery and novel endobronchial techniques have expanded the treatment options for post-lobectomy bronchial complications in selected patients.

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Endobronchial valves for bronchopleural fistula: pitfalls and principles

Cited by 20 publications

References 10 publications

Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing

Single application of airway stents in thoracogastric-airway fistula: results and prognostic factors for its healing

Surgically intractable bronchopleural fistula treated with endobronchial valve insertion by isolating the tract with indigo carmine: A case report

Post-lobectomy airways complications

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