A simple method of bronchial occlusion with silicone spigots (Endobronchial Watanabe Spigot; EWS^®) using a curette

Abstract

Background:Bronchial occlusion with an Endobronchial Watanabe Spigot (EWS) has been shown to be useful in managing prolonged bronchopleural fistulas and intractable hemoptysis. EWS bronchial occlusion using a curette is less technically demanding. This retrospective study evaluated the clinical utility and simplicity of this method.Methods:A total of 18 consecutive patients (15 men, 3 women, aged 47–85 years) who underwent bronchial occlusion using an EWS from April 2012 to August 2014 were evaluated. The method involves sticking the tip of a curette into an EWS to the first joint, allowing it to be turned in any direction or at any angle. The time required to occlude the target bronchus was measured on routinely recorded digital videos. Other parameters evaluated included success rates, complications, and clinical outcomes.Results:Of the 18 patients, 11 underwent bronchial occlusion for intractable pneumothorax, 5 for postoperative bronchopleural fistula, two for intractable empyema, and one for hemoptysis. Each patient required 1–7 EWSs (median 4). Target bronchi included the right upper (n = 8), left upper (n = 5), right lower (n = 2), left lower (n = 2), and right middle (n = 1) bronchi. The success rate of EWS insertion into the target bronchus was 100%. Time per EWS occlusion ranged from 65–528 sec (median 158.5 sec). Of the 62 insertions, 36 (58.1%) were completed within 3 min, and 58 (93.5%) within 5 min. Successful outcomes were observed in 15 (83.3%) of the 18 patients.Conclusions:EWS bronchial occlusion using a curette is a simple method for managing intractable bronchopleural fistulas in daily clinical settings.

Risk factors for post-bronchoscopy pneumonia: a case–control study

“…Pneumonia developed in 4.2% of the patients with endobronchial valves for advanced emphysema, and most of the cases were resolved by antibiotic treatment and valve removal 11 . Obstructive pneumonia also developed due to occlusion by endobronchial Watanabe spigots for refractory pneumothorax and resolved through antibiotic treatment and spigot removal 12 . A recent study suggested that the central tumor location was one of the risk factors for post-bronchoscopy pneumonia.…”

Endobronchial Valves for the Treatment of Bronchopleural Fistula and Pneumothorax Caused by Pulmonary Cryptococcosis in an AIDS Patient

“…There are other minimally invasive and bronchoscopic therapeutic options for prolonged air leakage, such as endobronchial Watanabe spigot (EWS), a type of silicone bronchial blocker. Previous studies revealed that EWS insertion was an effective modality for managing prolonged air leaks caused secondary to pneumothorax, empyema, and postoperative complications (7)(8)(9). Infection control at the target bronchus is important for a prolonged duration of EWS indwelling.…”

New treatment of bronchopleural fistula following surgical resection of the dorsal segment of the left lower lobe: A case report

“…SBO refers to the selective temporary closure of the draining bronchi leading to pleural fistulas (or ruptures) to block or significantly reduce the amount of air leakage from pleural fistulas. There are many forms of plugging agents reported in the literature; for example, autologous blood, autologous blood + thrombin, 7 n‐butyl cyanoacrylate glue, 8 and EWS (endobronchial Watanabe spigot, a silicone‐made bronchial filler) 9 . The absorbable gelatin sponge is a water‐soluble hemostatic material made from purified porcine gelatin that has ultra‐strong water absorption and is cheap and widely used in clinical practice.…”