Therapeutic closure of bronchopleural fistulas using ethanol

Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus© 21-gauge EBUS-TBNA (endobronchial ultrasound–transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.

1. Sirbu, H, Busch, T, Aleksic, I, et al Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management. Ann Thorac Cardiovasc Surg 2001; 7: 330–336.
Google Scholar | Medline2. Cerfolio, RJ. The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Thorac Cardiovasc Surg 2001; 13: 3–7.
Google Scholar | Crossref | Medline3. Fuso, L, Varone, F, Nachira, D, et al Incidence and management of post-lobectomy and pneumonectomy bronchopleural fistula. Lung 2016; 194: 299–305.
Google Scholar | Crossref | Medline4. Berry, MF, Harpole, DH. Bronchopleural fistula after pneumonectomy. In: Sugarbaker, DJ, Bueno, R, Colson, YL, et al (eds) Adult chest surgery. 2nd ed. New York: McGraw-Hill Education, 2015, pp. 475–485.
Google Scholar5. Cooper, WA, Miller, JI Management of bronchopleural fistula after lobectomy. Semin Thorac Cardiovasc Surg 2001; 13: 8–12.
Google Scholar | Crossref | Medline6. Lois, M, Noppen, M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005; 128: 3955–3965.
Google Scholar | Crossref | Medline | ISI7. Klotz, LV, Gesierich, W, Schott-Hildebrand, S, et al Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis 2015; 7: 1478–1482.
Google Scholar | Medline8. Gaspard, D, Bartter, T, Boujaoude, Z, et al Endobronchial valves for bronchopleural fistula: pitfalls and principles. Ther Adv Respir Dis 2017; 11: 3–8.
Google Scholar | SAGE Journals | ISI9. Wood, DE, Cerfolio, RJ, Gonzalez, X, et al Bronchoscopic management of prolonged air leak. Clin Chest Med 2010; 31: 127–133.
Google Scholar | Crossref | Medline10. Takaoka, K, Inoue, S, Ohira, S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 2002; 122: 374–378.
Google Scholar | Crossref | Medline

留言 (0)

沒有登入
gif