The efficacy of endobronchial valves for the treatment of bronchopleural fistula: a single-arm clinical trial

Abstract

Background: A bronchopleural fistula (BPF) is defined as communication between the bronchus and pleural cavity, and it is a dreaded complication of severe pulmonary disease. Surgical intervention, pleurodesis, and prolonged chest tube drainage have several disadvantages. To overcome these, many attempts have been made to treat BPF with bronchoscopy, especially with the insertion of an endobronchial one-way valve (EBV). Endobronchial valves for the treatment of BPF which had less trauma, relatively short operation time, better safety, and patients are more likely to accept this operation. If there is a definite efficacy, it should be widely used in later clinical practice. This study aimed to confirm the efficacy of endobronchial valves for the treatment of BPF.Methods: We retrospectively reviewed data from 26 patients who were treated for BPF using an EBV between August 2017 and October 2020. This sample constitutes all patients treated in our hospital (Shanghai Pulmonary Hospital, Tongji University School of Medicine) for this condition and with this intervention during this timeframe. We collected general information about the patient, complications of the procedure, and chest tube indwelling to assess the efficacy and safety of the procedure.Results: A total of 26 patients underwent EBV placement procedures; left upper lobe (LUL) was the most common lobe in which the valves were placed. The underlying etiologies for BPF were postoperative BPF (50%; n=14), pneumothorax (15%; n=4), non-tuberculosis mycobacteria (NTM) (19%; n=5), and tuberculosis (12%; n=3). Eleven patients underwent chest tube insertion. The average chest tube duration in the group of patients before receiving valves was 66 days (median, 65 days; range, 14-187 days). The average duration after which the chest tube was removed was 17.5 days after EBV placement (median, 7 days; range, 2-90 days). The effective rate of EBV for the treatment of BPF was 73.1%. Patients for whom the valves were not removed, there were no valve related complications.Conclusions: EBV placement is a relatively mature procedure, which is safe and effective, and generates less trauma and fewer complications. And this intervention may be suitable for wide application in clinical practice.

Complex bronchopleural fistulas: a case report

“…Song et al conducted a study on 26 patients, and found that approximately half of them developed BPF after surgery. 8 The effectiveness of EBV treatment was 73.1%, with minimal trauma, a short operation time, and few complications. Another study of 115 BPF cases also showed that EBV treatment was effective in >70% of patients without related complications.…”

“…The patient's preoperative chest tube indwelling time was 7 days, the postoperative drainage tube indwelling time was 34 days, and the time for successful removal of the EBV was 58 days, all of which were shorter than the times reported in Wang et al 7 Mild granulation tissue hyperplasia occurred after EBV removal, but there was no fistula recanalization, which is consistent with previous reports. 7,8 However, further research with a larger patient cohort is necessary to confirm these findings.…”

“…7 Mild granulation tissue hyperplasia occurred after EBV removal, but there was no fistula recanalization, which is consistent with previous reports. 7,8 However, further research with a larger patient cohort is necessary to confirm these findings.…”

Successful surgical treatment of bronchopleural fistula caused by severe pulmonary tuberculosis: A case report and review of literature

“…The size of BPF > 8 mm is generally unsuitable for bronchoscopic treatment[ 12 , 21 ]. The degree of infection, timing of diagnosis, underlying disease, localization and the size of the fistula may be the critical factors in choosing between surgical and bronchoscopic procedures for treatment[ 8 , 22 , 23 ]. In our case, as the bronchial stump was affected by tuberculosis and the right upper lung was damaged, we did not select the minimally invasive bronchoscopic method as a treatment strategy.…”

An update on bronchopleural fistulae following cancer-related surgery

“…Several novel case reports and case series make note of EBV placement for the management of BPF when surgical intervention cannot be performed. Song et al [58 ▪ ] reported on the use of EBV to close BPF in 26 patients, half of which were postoperative BPF. Overall, 19/26 (73.1%) achieved BPF closure.…”