Tratamento endoscópico de fístulas da árvore traqueobrônquica com dispositivos para a correção de defeitos do septo interatrial: resultados preliminares

Abstract

fistulas ranges from 0 to 28%, (1,2) and the mortality rate ranges from 16 to 72%. Non-neoplastic tracheoesophageal fistulas can be congenital, (4,5) iatrogenic (6) or related to thoracic trauma. Once such a fistula has been diagnosed, surgical closure is formally indicated. IntroductionFistulas in the tracheobronchial tree have a multifactorial etiology and present a variable incidence in the literature. The related morbidity and mortality are high. Bronchopleural fistulas usually result from surgical procedures involving pulmonary resection; the incidence of these Endoscopic treatment of tracheobronchial tree fistulas using atrial septal defect occluders: preliminary results* AbstractFistulas in the tracheobronchial tree (bronchopleural and tracheoesophageal fistulas) have a multifactorial etiology and present a variable incidence in the literature. In general, the related morbidity and mortality are high. Once such a fistula has been diagnosed, surgical closure is formally indicated. However, the clinical status of affected patients is usually unfavorable, which precludes the use of additional, extensive surgical interventions. In addition, attempts at endoscopic closure of these fistulas have seldom been successful, especially when the fistula is large in diameter. We report the cases of three patients submitted to endoscopic closure of fistulas, two of which were larger than 10 mm in diameter, by means of the insertion of atrial septal defect occluders. The procedure was minimally invasive, and the initial results were positive. The results indicate that this is a promising technique for the resolution of tracheobronchial tree fistulas.Keywords: Bronchial fistula; Tracheoesophageal fistula; Bronchoscopy; Respiratory therapy. ResumoAs fístulas da árvore traqueobrônquica, sejam elas broncopleurais ou traqueoesofágicas, apresentam etiologia multifatorial, com incidência variável na literatura. Em geral, apresentam alta morbidade e mortalidade, com indicação formal de correção cirúrgica. Entretanto, a condição clínica dos pacientes muitas vezes não permite uma reintervenção cirúrgica de grande porte. Além disso, as tentativas de fechamento endoscópico raramente têm sucesso, principalmente em fístulas de grande diâmetro. Relatamos os casos de três pacientes submetidos ao fechamento endoscópico de fístulas, sendo duas maiores que 10 mm, com a aplicação de dispositivos oclusores utilizados na cardiologia intervencionista, de forma minimamente invasiva e com resultados iniciais positivos. Esses dados sinalizam que essa pode ser uma técnica promissora na resolução de fístulas da árvore traqueobrônquica.

Efficacy of Bronchoscopic Closure of a Bronchopleural Fistula with Amplatzer Devices: Long-Term Follow-Up

“…Following our initial report using AD to seal BPF [15,16], several other groups [24,25,26] have described their experience with this technique. Scordamaglio et al [24] described a 53-year-old patient who underwent right upper lobectomy due to aspergilloma with hemoptysis and developed BPF at the right upper lobe stump. The patient was successfully treated by bronchoscopic closure of the fistula using an AD and was doing well at the 6-month follow-up.…”

Chronic Tracheoesophageal Fistula Successfully Treated Using an Amplatzer Closure Device Under Endoscopic Visualization

“…7 Similarly, Scordamaglio et al and Gulkarov et al found successful closure of BPFs with ADs in all 3 patients, with an asymptomatic 6-month follow-up. 11,12 It is suggested that the placement of AD induces granulation tissue formation around the device, allowing for complete closure of the fistula without compromising airway patency. Using the same techniques as those for the repair of BPFs and ASDs, AD can be used for the treatment of TEFs.…”

Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula

“…The rational for bronchoscopic treatment of BPF in patients whose clinical condition precludes surgical correction is the fact that the placement of an occluder in the bronchial stump results in rapid improvement of symptoms. In a previous study conducted by our group, we reported our experience with the bronchoscopic treatment of fistulas ( 14 - 16 ) .…”