Clinical evaluation of endoscopic bronchial closure of Peripheral Bronchopleural Fistula with customized silicone plug_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Cuihua , LIU Zhiguang , CHEN Fengyu , ZHANG Weidong , DENG Hongying , LI Rong , PENG Ran ,  TAN Jianlong

Department of Respiratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R.China;

Corresponding author：

TAN Jianlong, Email: jianlongtan@163.om

Keywords：

Bronchopleural Fistula; Bronchoscope; Silicone Plug; Spontaneous Pneumothorax

DOI：

10.7507/1671-6205.202404058

Video：

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Objective To explore the safety and efficacy of the treatment of peripheral bronchopleural fistula with customized silicone plug through bronchoscope. Methods A total of 19 patients with BPF admitted to Hunan Provincial People’s Hospital from July 2017 to May 2023 were included. Detailed medical records of the patients were collected, including etiology, fistula location, treatment methods, complications, and effective rates, to assess the safety and efficacy of customized silicone plug occlusion. Results The average age of the 19 patients was 61.58 years (range from 42～84 years). The fistulas were located at the right upper lobe in 8 cases, the right middle lobe in 2 cases, the right lower lobe in 2 cases, the left upper lobe in 2 cases, and the left lower lobe in 5 cases. Causes included 9 cases after pneumonectomy, 6 cases of spontaneous pneumothorax, 1 case post Microwave Ablation Therapy for lung nodule, 1 case of advanced lung cancer under radiotherapy and chemotherapy, 1 case of candidal pneumonia, and 1 case of pulmonary tuberculosis. 15 patients were successfully occluded for the first time, 1 case failed to place the plug, and 3 cases had silicone plug dislodgement within 1 week after the procedure, with a short-term effective rate of 73.68% (14 cases). A total of 40 customized silicone plugs were placed, with an average of (2.10±0.74), and the mean diameter of the plugs used was 6.4 mm, with a range of 3 to 9 mm. Fifteen patients were recruited for long-term follow-up, with a median follow-up time of 15 months (range from 1.5 to 53 months). One patient developed a new fistula on the 45th day, who was treated with a combined small Y-type single bullet-covered stent for occlusion. One patient died of severe pneumonia 3 months postoperatively, and one died of type II respiratory failure at the 30th month, both deaths were unrelated to the interventional procedure. The long-term effective rate was 68.42% (13 cases). Conclusion Placing customized silicone plugs through bronchoscopy can rapidly and effectively occlude peripheral BPF, with satisfactory long-term outcome.

Citation： ZHANG Cuihua, LIU Zhiguang, CHEN Fengyu, ZHANG Weidong, DENG Hongying, LI Rong, PENG Ran, TAN Jianlong. Clinical evaluation of endoscopic bronchial closure of Peripheral Bronchopleural Fistula with customized silicone plug. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(8): 552-557. doi: 10.7507/1671-6205.202404058 Copy

1.	Jin L, Li Y. Bronchoscopic interventions for bronchopleural fistulas. Ther Adv Respir Dis. 2023, 17: 17534666231164541.
2.	Bazzocchi R, Bini A, Grazia M, et al. Bronchopleural fistula prevention after major pulmonary resection for primary lung cancer. Eur J Cardiothorac Surg, 2002, 22(1): 160.
3.	Boudaya MS, Smadhi H, Zribi H, et al. Conservative management of postoperative bronchopleural fistulas. J Thorac Cardiovasc Surg, 2013, 146(3): 575-579.
4.	谭建龙, 陈风雨, 欧阳彬, 等. 经支气管镜置入房间隔缺损封堵器治疗中心型气道胸膜瘘的临床疗效评价. 中国呼吸与危重监护杂志, 2023, 22(06): 403-407.
5.	Yutaka Y, Yuasa I, Itotani R, et al. A novel guidewire technique for endobronchial silicone plug occlusion for bronchopleural fistula. Multimed Man Cardiothorac Surg, 2021, 13;2021.
6.	占丰富, 黄茂宏, 洪平阳, 等. 经支气管镜自体血、硅胶塞及生物胶联合封堵术治疗脓胸后支气管胸膜瘘一例. 中国呼吸与危重监护杂志, 2023, 22(04): 281-284.
7.	Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg, 2020, 26(6): 311-319.
8.	Zeng J, Wu X, Chen Z, et al. Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases. BMC Pulm Med, 2021, 21(1): 10.
9.	王海, 于冬梅, 顾晔, 等. 支气管单向活瓣在支气管胸膜瘘治疗中的效果及安全性分析. 中华医学杂志, 2022, 102(44): 3520-3524.
10.	Watanabe Y, Hiraki S, Araki M. Bronchial embolization using dental impressin material in a case of pyelo-bronchial fistula with candida fungemia (in Japanese with English abstract). J Jpn Soc Bronchol, 1991, 13: 607-610.
11.	Himeji D, Tanaka GI, Fukuyama C, et al. Clinical Evaluation of Endoscopic Bronchial Occlusion with an Endobronchial Watanabe Spigot for the Management of Intractable Pneumothorax, Pyothorax with Bronchial Fistula, and Postoperative Air Leakage. Intern Med, 2020, 59(15): 1835-1839.
12.	Lin H, Wang Y, Lu D, et al. A novel method for the bronchial occlusion of prolonged air leakage using customized endobronchial plugs. J Thorac Dis, 2023, 15(12): 6419-6426.
13.	Mizumori Y, Nakahara Y, Hirata N, et al. Toward Easy and Rapid Bronchial Occlusion With an Endobronchial Watanabe Spigot: A New Technique Using a Guide Sheath and Curette. J Bronchology Interv Pulmonol, 2020, 27(2): 122-127.
14.	Kaneda H, Minami K, Nakano T, et al. Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks. Respir Investig, 2015, 53(1): 30-36.

1. Jin L, Li Y. Bronchoscopic interventions for bronchopleural fistulas. Ther Adv Respir Dis. 2023, 17: 17534666231164541.
2. Bazzocchi R, Bini A, Grazia M, et al. Bronchopleural fistula prevention after major pulmonary resection for primary lung cancer. Eur J Cardiothorac Surg, 2002, 22(1): 160.
3. Boudaya MS, Smadhi H, Zribi H, et al. Conservative management of postoperative bronchopleural fistulas. J Thorac Cardiovasc Surg, 2013, 146(3): 575-579.
4. 谭建龙, 陈风雨, 欧阳彬, 等. 经支气管镜置入房间隔缺损封堵器治疗中心型气道胸膜瘘的临床疗效评价. 中国呼吸与危重监护杂志, 2023, 22(06): 403-407.
5. Yutaka Y, Yuasa I, Itotani R, et al. A novel guidewire technique for endobronchial silicone plug occlusion for bronchopleural fistula. Multimed Man Cardiothorac Surg, 2021, 13;2021.
6. 占丰富, 黄茂宏, 洪平阳, 等. 经支气管镜自体血、硅胶塞及生物胶联合封堵术治疗脓胸后支气管胸膜瘘一例. 中国呼吸与危重监护杂志, 2023, 22(04): 281-284.
7. Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg, 2020, 26(6): 311-319.
8. Zeng J, Wu X, Chen Z, et al. Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases. BMC Pulm Med, 2021, 21(1): 10.
9. 王海, 于冬梅, 顾晔, 等. 支气管单向活瓣在支气管胸膜瘘治疗中的效果及安全性分析. 中华医学杂志, 2022, 102(44): 3520-3524.
10. Watanabe Y, Hiraki S, Araki M. Bronchial embolization using dental impressin material in a case of pyelo-bronchial fistula with candida fungemia (in Japanese with English abstract). J Jpn Soc Bronchol, 1991, 13: 607-610.
11. Himeji D, Tanaka GI, Fukuyama C, et al. Clinical Evaluation of Endoscopic Bronchial Occlusion with an Endobronchial Watanabe Spigot for the Management of Intractable Pneumothorax, Pyothorax with Bronchial Fistula, and Postoperative Air Leakage. Intern Med, 2020, 59(15): 1835-1839.
12. Lin H, Wang Y, Lu D, et al. A novel method for the bronchial occlusion of prolonged air leakage using customized endobronchial plugs. J Thorac Dis, 2023, 15(12): 6419-6426.
13. Mizumori Y, Nakahara Y, Hirata N, et al. Toward Easy and Rapid Bronchial Occlusion With an Endobronchial Watanabe Spigot: A New Technique Using a Guide Sheath and Curette. J Bronchology Interv Pulmonol, 2020, 27(2): 122-127.
14. Kaneda H, Minami K, Nakano T, et al. Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks. Respir Investig, 2015, 53(1): 30-36.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical evaluation of endoscopic bronchial closure of Peripheral Bronchopleural Fistula with customized silicone plug

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