Clinical Application of Fully Covered Self-Expandable Metal Stents in the Treatment of Bronchial Fistula
23. Juli 2014
27. Oktober 2014
12. Januar 2015 (online)
Background The study was designed to access the feasibility, safety, and efficacy of fully covered self-expandable metal stents in the treatment of bronchial fistula.
Methods Clinical data of nine patients (seven males and two females) who were treated with placement of tracheobronchial or bronchial fully covered self-expandable metal stents from August 2005 to November 2011 were analyzed retrospectively. Among these patients, seven were diagnosed with bronchopleural fistula, one with tracheopleural fistula, and one with left main bronchoesophageal fistula. Eight had accompanying thoracic empyema. The fistula orifices ranged from 3.5 mm to 25 mm in diameter. All patients received topical anesthesia. L-shaped stents were placed in six patients and I-shaped stents in three under fluoroscopic guidance. After stent placement, patients with empyema were treated with pleural lavage.
Results Stent placement in the tracheobronchial tree was successful in all patients, without procedure-related complications. The operating time was 5 to 16 minutes. A small amount of bubble overflowed from the intrathoracic drainage tube of only one patient. In the other patients, the bubble in the intrathoracic drainage tube disappeared immediately or angiography showed no overflow of contrast agent from the fistula orifice. The effective rate of fistula orifice closure after stent placement was 100%, with 88.9% rated as excellent. One patient coughed the stent out 5 days after placement and hence a new stent was placed. Among the patients with empyema, one died of septicemia arising from empyema on day 8 and another died of brain metastases of lung cancer 6 months after stent insertion with persistent empyema. In the other six patients, empyema resolved after 2 to 5 months (cure rate 75%). Seven patients were followed up for 3 to 36 months. During follow-up, one stent was removed 8 months after implantation due to difficult expectoration, without recurrent empyema. The remaining patients tolerated the stents well. The stents remained stable without migration or empyema recurrence, and they could eat and drink well.
Conclusion The use of fully covered self-expandable metal stents is a safe, effective, and fast minimally invasive method to treat bronchial fistula, especially for selected cases with empyema.
- 1 Zeng YM. [Diagnosis and management of bronchial fistula]. Zhonghua Jie He He Hu Xi Za Zhi 2012; 35 (6) 406-408 . Retrieved from http://d.g.wanfangdata.com.cn/Periodical_zhjhhhx201206004.aspx [in Chinese]
- 2 Sarkar P, Patel N, Chusid J, Shah R, Talwar A. The role of computed tomography bronchography in the management of bronchopleural fistulas. J Thorac Imaging 2010; 25 (1) W10-3
- 3 Fruchter O, Kramer MR, Dagan T , et al. Endobronchial closure of bronchopleural fistulae using Amplatzer devices: our experience and literature review. Chest 2011; 139 (3) 682-687
- 4 Wang DL, Cheng GY, Sun KL, Meng PJ, Fang DK, He J. [Treatment and prevention of bronchus-pleural fistula after pneumonectomy for lung cancer]. Zhonghua Wai Ke Za Zhi 2008; 46 (3) 193-195 . Retrieved from http://d.g.wanfangdata.com.cn/Periodical_zhxxxgwk200706020.aspx [in Chinese]
- 5 Stefani A, Jouni R, Alifano M , et al. Thoracoplasty in the current practice of thoracic surgery: a single-institution 10-year experience. Ann Thorac Surg 2011; 91 (1) 263-268
- 6 Deschamps C, Allen MS, Miller DL, Nichols III FC, Pairolero PC. Management of postpneumonectomy empyema and bronchopleural fistula. Semin Thorac Cardiovasc Surg 2001; 13 (1) 13-19
- 7 Sarkar P, Chandak T, Shah R, Talwar A. Diagnosis and management bronchopleural fistula. Indian J Chest Dis Allied Sci 2010; 52 (2) 97-104
- 8 Ranu H, Gatheral T, Sheth A, Smith EE, Madden BP. Successful endobronchial seal of surgical bronchopleural fistulas using BioGlue. Ann Thorac Surg 2009; 88 (5) 1691-1692
- 9 Kramer MR, Peled N, Shitrit D , et al. Use of Amplatzer device for endobronchial closure of bronchopleural fistulas. Chest 2008; 133 (6) 1481-1484
- 10 Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005; 128 (6) 3955-3965
- 11 Lang-Lazdunski L. Closure of a bronchopleural fistula after extended right pneumonectomy after induction chemotherapy with BioGlue surgical adhesive. J Thorac Cardiovasc Surg 2006; 132 (6) 1497-1498
- 12 West D, Togo A, Kirk AJ. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy?. Interact Cardiovasc Thorac Surg 2007; 6 (4) 547-550
- 13 Andreetti C, D'Andrilli A, Ibrahim M , et al. Effective treatment of post-pneumonectomy bronchopleural fistula by conical fully covered self-expandable stent. Interact Cardiovasc Thorac Surg 2012; 14 (4) 420-423
- 14 Han X, Wu G, Li Y, Li M. A novel approach: treatment of bronchial stump fistula with a plugged, bullet-shaped, angled stent. Ann Thorac Surg 2006; 81 (5) 1867-1871
- 15 Miller JI, Fleming WH, Hatcher Jr CR. Balanced drainage of the contaminated pneumonectomy space. Ann Thorac Surg 1975; 19 (5) 585-588
- 16 Watanabe S, Shimokawa S, Yotsumoto G, Sakasegawa K. The use of a Dumon stent for the treatment of a bronchopleural fistula. Ann Thorac Surg 2001; 72 (1) 276-278
- 17 Zang Q, Wang W, Jiang ZM, Zhu Q, Shi Y. The application of bronchial stents in treating bronchopleural fistula. Chin J Thorac and Cardiovasc Surg 2007; 23: 417-418