Silicone blockers for bronchial leaks: Expanding the literature base with a larger and longer experience in this complex entity

Abstract

To the Editor We noted with interest the case series presented by Zhao et al., 1 on selective bronchial occlusion using a customized silicone blocker for broncho-biliary fistula. Certain key aspects deserve mention:1. There is scant literature on the use of occlusive blockers as an effective strategy in bronchial or alveolar fistulae, and most of the available literature pertains to PAL (prolonged air leak), which is either due to alveolar pleural fistula (APF) or bronchopleural fistula (BPF). 2. We have reported in 2 publications, the use of a similar blocker indigenously produced and named by us as the CESB (customize endobronchial silicon blocker). The CESB is made on the spot using readily available silicon stents, and shown to be an effective strategy for PAL. In our report, the success rate of these was 83.3%. We suggest the authors check the relevant publications referenced below, 2,3 one of which is in the same journal (Respirology Case Reports). In our opinion, our innovation is described earlier and has many advantages, and the discussion and review of literature of this report will be augmented with a comparison of both devices and referencing our articles. 3. To add to this further, the cardinal difference between the blocker used by the authors and our blocker (CESB) is that ours can be made by anybody using easily available material, while the personalized silicone plugs used by the authors seem to be commercially manufactured in the country of the report. The CESB can be customized on site, has a mild and easy learning curve with the technique well described in the referenced paper. The distinct advantage is ease of production, applicability in any part of the world, and sizing as per requirement, with adjustment in case there is any sizing issue. 4. Of note, the suture applied to the blocker to facilitate insertion/removal is very similar to our technique described in the publication in 2018, 2 referred by us as a 'bucket handle stitch', to facilitate removal of the blocker after the primary problem with the PAL was resolved. (Figure 1) 5. In summary, these innovative techniques help in these complex situations where options are few, stakes are high and favourable outcomes can be achieved in a short span of time. Our addition to literature with the CESB precedes this report with experience in a much larger cohort of patients for a longer duration, albeit in a PAL situation.