The Use of Polyvinyl Alcohol Sponge and Cyanoacrylate Glue in the Treatment of Large and Chronic Bronchopleural Fistulae following Lung Cancer Resection

Abstract

Background: Bronchopleural fistulae represent a relatively rare complication of pulmonary resection. For inoperable patients, several endoscopic procedures have been described. In the presence of large and chronic bronchopleural fistulae, persistent air leaks require a surgical therapy, while endoscopic airway stent represents a useful palliative treatment. Objective: We describe the successful closure of large and chronic bronchopleural fistulae using an expandable polyvinyl alcohol (PVA) sponge and cyanoacrylate glue. Methods: In all patients, a rigid bronchoscope was used to insert a small cylinder of PVA sponge within the fistula. After releasing the patch, cyanoacrylate glue was applied directly on the PVA sponge using a channel catheter. This methodology induces an expansion of the clot and the closure of the air leak. The long-term outcome of treatment was checked by flexible bronchoscopy once every month for 3 months and every 6 months until 5 years. Results: We performed endoscopic treatment in 7 consecutive patients with bronchopleural fistula ranging from 4 to 8 mm. In 6 of 7 patients, the bronchial stump was the site of the fistula. In 1 patient, the fistula was visualized on the right wall of the distal trachea. A temporary complete occlusion of the fistula was achieved in 7 of 7 patients and a definitive result in 5 of 7 patients. Conclusions: The use of an expandable PVA sponge and cyanoacrylate glue is an available strategy for endobronchial closure of bronchopleural fistulae.

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

“…Among the sealants reported are autologous blood [15, 16], fibrin glue [24], cyanoacrylate glue [25, 26], oxidized cellulose [27], albumin-glutaraldehyde glue [28], and hydrogel [29]. Autologous blood was used as the injection material to treat pneumothorax and PAL, not only because of its favourable bioadhesive properties, but also because it is relatively safe and is easily archived [15].…”

Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report

“…This includes dependent drainage, reduction of the pleural space, antibiotic treatment, nutritional supplementation, and, if needed, ventilator management [ 13 ]. Closure of the fistula is then performed with either airway stents, coils, occlusive agents, or Amplatzer devices [ 14 , 15 ]. Patients should then be monitored for clinical signs of fistula recurrence, air in the chest tube, and imaging of pleural space to ensure closure of the defect [ 12 ].…”

Progress Report on Interventional Treatment for Bronchopleural Fistula

“…This therapeutic approach for chronic empyema and bronchopleural fistulas, delivered through fiberoptic bronchoscopy, has proven straightforward to implement and minimally painful for the patients. Battistoni et al [ 19 ] performed endoscopic treatment on 7 patients with a fistula diameter of 4–8 mm. They used rigid bronchoscopy to insert the small cylinder of PVA sponge into the fistula and then directly coated the cyanoacrylate adhesive to the PVA sponge through the channel catheter, once a month for 3 months, to achieve good results.…”