Insertion of an endobronchial silicone spigot under retrograde guidewire assistance: a simple technique for bronchopleural fistula closure

K. Fukumoto*^a (Dr), N. Hiyama^a (Dr), J. Matsumoto^a (Dr)

^a NTT Medical Center Tokyo, Tokyo, JAPAN

* kentojf@gmail.com

Background

Treatment of empyema is difficult and often has an intractable course, especially if bronchopleural fistula exists. Closing the fistula is essential for successful treatment of empyema, and bronchial occlusion using silicone spigot, including Endobronchial Watanabe Spigot (EWS), is a promising approach. However, inserting spigots into sharp angled bronchi under endoscopic manoeuvre is often technically demanding.

Case report

A 73-year-old man underwent chest wall tumour resection combined with deep wedge resection of upper and lower lobe of the right lung for postoperative chest wall recurrence of oesophageal carcinoma. Eleven months later, he developed empyema and open-window thoracostomy was immediately performed. Multiple bronchopleural fistulae were noted.

From the open wound we inserted a guidewire into each fistula, and identified that B3b, B6b+c, B8b were the responsible bronchi. The guidewire was endoscopically introduced out of the endotracheal tube, and we pierced the guidewire through the silicone spigot. Then, under endoscopic observation, silicone spigots were automatically inserted, and fixed into each fistula by pulling the guidewire. After the procedure, negative-pressure wound therapy (NPWT) was firmly applied to the open wound with no air leakage.

Conclusion

This retrograde guidewire insertion technique of silicone spigots is an effective method for treatment of bronchopleural fistula.

Disclosure of funding source(s): none