Bronchial Occlusion with Endobronchial Watanabe Spigot for Hemoptysis in a Mechanically Ventilated Patient with Extracorporeal Circulation

Sakaguchi, Tadashi; Kida, Hirotaka; Kanno, Yuki; Oyama, Baku; Inoue, Tatsuya; Miyazawa, Teruomi; Mineshita, Masamichi

doi:10.2169/internalmedicine.1176-18

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…We were unable to achieve complete hemostasis in this case; however, temporary hemostasis was achieved with EBO+EWS. Previous studies have reported the effectiveness of EBO+EWS for hemostasis [ 5 , 7 – 27 ]. We analyzed 33 previously reported cases from 22 articles, in addition to our case.…”

Section: Discussionmentioning

confidence: 99%

“…EBO can be performed with bronchial blockers [ 4 ]. The endobronchial Watanabe spigot (EWS) is a silicone filter for refractory pneumothorax and bronchial fistulas and can be used to manage hemoptysis [ 5 , 6 ]. To perform EBO with an EWS, a bronchoscope is used to fill the bleeding bronchus with an EWS, which is grasped by forceps while the patient is intubated [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…To perform EBO with an EWS, a bronchoscope is used to fill the bleeding bronchus with an EWS, which is grasped by forceps while the patient is intubated [ 6 ]. Reports on cases of hemoptysis managed by EBO with EWS (EBO+EWS) are limited [ 5 , 7 – 27 ]. Two types of cases exist in which BAE and EBO are combined to achieve hemostasis in hemoptysis.…”

Section: Introductionmentioning

confidence: 99%

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A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review

Yoneoka,

Takeda,

Kasai

et al. 2024

Am J Case Rep

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Patient: Male, 65-year-old Final Diagnosis: Hypoxemia due to hemoptysis Symptoms: Hemoptysis Clinical Procedure: Bronchial artery embolization, endobronchial occlusion Specialty: Pulmonology Objective: Management of emergency care Background: Hemoptysis due to airway hemorrhage is treated with hemostatic agents, bronchial artery embolization (BAE), or surgical resection. We present the case of a 65-year-old man with refractory hemoptysis associated with chronic progressive pulmonary aspergillosis (CPPA) who failed to respond to combined endobronchial occlusion (EBO) with endobronchial Watanabe spigot (EWS) and BAE. Case Report: A 63-year-old man was diagnosed with CPPA in the right upper lung and presented to our hospital 2 years later for hemoptysis at age 65. He developed severe hemoptysis during an outpatient visit, and was urgently admitted, intubated, and ventilated to prevent choking on blood clots. Chest computed tomography showed a large mass in the apical portion of the right lung, constituting apical pleural thickening and an encapsulated pleural effusion, and dilatation in the bronchial artery supplying the right upper lung lobe. Bronchoscopy revealed the right upper lobe B 1 -B 3 as the bleeding source. The patient had recurrent hemoptysis that was not controlled by BAE or 6 EBO+EWS procedures, and he ultimately died of hypoxemia. In the literature review, EBO+EWS can effectively control hemoptysis in appropriate cases, without the need for BAE or surgical lung resection. It is less invasive, is associated with fewer adverse events than BAE or surgery, and can achieve temporary hemostasis for severe hemoptysis. Conclusions: BAE and EBO+EWS were ineffective in controlling recurrent hemoptysis caused by CPPA in this case. However, a multidisciplinary approach such as attempting hemostasis with combined EBO+EWS and BAE may be a viable treatment option in severe cases of hemoptysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review

Yoneoka,

Takeda,

Kasai

et al. 2024

Am J Case Rep

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“…In recent years, minimally invasive methods have become more preferred in the management of patients with a tracheal injury who are under high surgical risk due to the severity of the underlying disease and comorbidity. The first of these methods is the “watanabe spigot” silicone tube with a conical shape and protrusions on the sides to hold onto the bronchial wall designed by a Japanese pulmonologist in three different sizes (5, 6 and 7 mm) [ 65 ]. Such devices were originally introduced in clinical practice to treat persistent pneumothorax with pulmonary fistula and prolonged air leaks.…”

Section: Non-surgical Approachesmentioning

confidence: 99%

Airway management in penetrating thoracic trauma

Çakmak¹,

Cansun

Saraçoğlu³

et al. 2022

ait

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Approximately 20-25% of deaths due to trauma in the first four decades of life result from thoracic trauma [1]. Penetrating thoracic trauma is present in 33% of deaths due to thoracic trauma [2]. in a 1972 autopsy study involving 1178 trauma patients, 82% of the patients with tracheobronchial injuries died at the accident site; 30% of those who could come to the hospital also died. it was observed that 50% of these losses occurred in the first hour [3].Between 2001 and 2005, a total of 1033 tracheal injuries were reported over five years in Germany [4]. According to the US Centers for Disease Control and Prevention (CDC), while the medical costs of approximately 12 000 patients who died in 2005 due to firearm assault injury were more than $60 million, it was reported that the loss of work and productivity was 18 billion dollars. Between 2000 and 2005, the average hospital cost for adults over the age of 18 who had a penetrating injury was estimated at £7983 in the UK [5]. it was observed that mortality in thoracic trauma patients was 36% before 1950 and decreased to 9% after 1970 [6].

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“…The flexible bronchoscopy is instrumental in identifying the source of bleeding, 3 and bronchial occlusion with endobronchial Watanabe spigots (EWSs) has been reported as an option, and at times, definitive treatment for massive haemoptysis unfit for interventional radiology (IVR) and surgery. 4 …”

Section: Introductionmentioning

confidence: 99%

Bronchial occlusion with endobronchial Watanabe spigots using a two‐scope technique for massive haemoptysis

Baba,

Ito,

Sato

et al. 2024

Respirology Case Reports

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Massive haemoptysis is a life‐threatening condition whose cause needs to be identified rapidly so that prompt interventions can ensue. Bronchial occlusion with endobronchial Watanabe spigots (EWSs) may be useful when endovascular treatment or surgery proves to be difficult. An 84‐year‐old woman developed massive haemoptysis during percutaneous mitral valve repair for refractory heart failure due to severe mitral regurgitation (MR). Interventional radiology (IVR) and surgery were contraindicated, and bronchial occlusion with EWSs was attempted to control bleeding. The bleeding was so persistent that it was difficult to secure the visual field without aspiration with a bronchoscope. Herein, we report a two‐scope technique, also used in cryobiopsy of peripheral lung lesions, to control bleeding and perform bronchial occlusion with EWSs.

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Bronchial Occlusion with Endobronchial Watanabe Spigot for Hemoptysis in a Mechanically Ventilated Patient with Extracorporeal Circulation

Cited by 7 publications

References 6 publications

A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review

A 65-Year-Old Man with Refractory Hemoptysis Associated with Chronic Progressive Pulmonary Aspergillosis Who Failed to Respond to Combined Endobronchial Occlusion and Bronchial Artery Embolization: A Case Report and Literature Review

Airway management in penetrating thoracic trauma

Bronchial occlusion with endobronchial Watanabe spigots using a two‐scope technique for massive haemoptysis

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