Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation

Abstract

A 68‐year‐old woman with interstitial lung disease related to dermatomyositis and systemic scleroderma was admitted to our hospital with fever and dyspnoea. Although the fever was reduced after antibiotic therapy, a left pneumothorax suddenly occurred on day 27 after admission. A continuous air leak persisted despite chest drainage with three tubes and repeated pleurodesis. Chest computed tomography (CT) images showed a cavitary lesion with a pinhole in the left upper division, which was suspected to be the affected lesion with the air leak. Virtual bronchoscopic navigation images were constructed from CT data. Bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) was performed on day 52. Two medium‐sized EWSs were inserted into the left B1 + 2a and B1 + 2b, and the air leak stopped immediately. No procedure‐related adverse events occurred. All three chest tubes were successfully removed by day 60. This case demonstrates that virtual bronchoscopic navigation can improve bronchial occlusion procedures using EWSs.

The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy

“…Even so, more and more hospitals have been set up a technical team to decrease the increasing adverse events of flexible bronchoscopy. [5,6] Recently, the anesthetic technique of monitored anesthesia care (MAC) without respiratory depression has been widely used. [7] The most commonly used anesthetic agents include midazolam, propofol, etomidate, opioids, and inhalation anesthetics, however, each of these drugs has its limitations.…”

Pneumothorax in connective tissue disease-associated interstitial lung disease

“…Alternative therapeutic approach should be considered for patients with pneumothorax refractory to thoracic drainage. Recently, the efficacy of Endobronchial Watanabe Spigot (EWS) has been reported for patients with refractory pneumothorax in ILD [ 31 ]. The combination of such treatments might be effective for patients with refractory pneumothorax in CTD-ILD, although further studies will be required.…”

Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

“…As reported previously, many bronchoscopic attempts to treat BPF have been described and include mechanical abrasion, vascular coils, fibrin or tissue glue, spigots, stents, silver nitrate, autologous endobronchial blood patches, and endobronchial valves. [ 2 , 6 , 9 , 15 – 19 ] In our case, because the fistula seemed to be relatively small, we did not use silicon spigots or vascular coils, which are likely to be effective for larger fistulae. [ 9 ] Moreover, we did not apply mechanical abrasion or submucosal injection because we feared that those procedures might deteriorate the fistula.…”

“…Moreover, the successful use of VBN for endobronchial procedures has been previously described. [ 6 ] CT fluoroscopy also played an important role in this case because it was necessary to confirm the location of the catheter. Notably, the NBCA used in this case could not be applied in the normal bronchi.…”

“…[ 4 , 5 ] However, few reports have described the successful use of these techniques for bronchial fistula closure. [ 6 ] We herein report a case of postoperative BPF with persistent air leakage that was successfully treated with endoscopic bronchial closure supported by CT fluoroscopy guidance and VBN. We obtained informed consent from the patient for reporting this case.…”