Temporary Endobronchial Embolization with Silicone Spigots for Moderate Hemoptysis: A Retrospective Study

Abstract

Background: The management of airway bleeding is generally performed in an emergency to prevent hypoxemia and lung flooding. When the bleeding arises from peripheral lesions that are not visible endoscopically, bronchoscopic options have limited curative intents. Endobronchial embolization using silicone spigots (EESS) is a novel approach. Objectives: We analyzed the efficacy and safety of EESS in a retrospective study. Methods: We retrospectively reviewed charts of patients referred to our center for moderate hemoptysis (MH) who underwent EESS. Successful management is defined as immediate bleeding cessation. Results: From December 2008 to January 2012, 9 patients were treated with EESS in our endoscopy unit. The MH originated from the left upper lobe in 4 cases, the right upper lobe in 3 cases and the right middle lobe and left lower lobe in 1 case each. Thirteen spigots were inserted. The success rate was 78%. Of the 9 patients, 7 were referred to interventional radiology for bronchial artery embolization, with a success rate of 86%, and 2 were referred for thoracic surgery. One patient had EESS as definitive treatment; the silicone spigots were bronchoscopically removed after a median of 4 days in 6 of the remaining 8 patients. Only 2 patients had hemoptysis recurrence after a median follow-up of 107 days (ranging from 13 to 1,017 days). None of the patients died from hemoptysis. Conclusion: EESS is an original, temporary technique that requires only a flexible bronchoscope and biopsy forceps for placement and removal. EESS ensures airway protection while waiting for definitive management.

Management Considerations for the Treatment of Idiopathic Massive Hemoptysis with Endobronchial Occlusion Combined with Bronchial Artery Embolization

“…There are a few previous reports concerning EESS as a temporary treatment for hemoptysis (5). To the best of our knowledge, this is a rare case in which radical treatment of intractable idiopathic hemoptysis was achieved through the complementary use of BAE.…”

“…Endobronchial embolization using silicone spigots (EESS) is known to be an effective treatment for fistulous diseases of the lungs (2,3). More recently, articles have reported EESS as a temporary treatment for hemoptysis, as it can secure the respiratory tract until definitive treatment (4)(5)(6). However, there have been no reports on the use of EESS as a definitive treatment for refractory hemoptysis.…”

Endobronchial embolization using a watanabe spigot for persistent air leakage

“…The utility of EWSwas previously reported for selected cases [7,8], including cases of hemoptysis [9]. Interestingly, even for EWS occlusion of the responsible bronchus, the involved lobe remained inflated.…”

Endobronchial Sealing With Glue for Malignant Hemoptysis

“…In our experience, placement of silicone spigot is an efficient immediate, temporary strategy to occlude bronchus, until a more definitive measure can be carried out. 3,4 However, in this particular patient an attempt to place a spigot failed due to difficult anatomic location. Subsequently, we decided to seal the bronchus with the cyanoacrylate glue; a tool that can be considered as a definitive treatment.…”