Abstract
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.
Keywords
bronchial fistula - fully covered self-expandable metal stents - empyema
