1
|
Kouladouros K, Kähler G. [Endoscopic management of complications in the hepatobiliary and pancreatic system and the tracheobronchial tree]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:469-484. [PMID: 36269350 DOI: 10.1007/s00104-022-01735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 05/04/2023]
Abstract
Endoscopic methods are nowadays a priceless tool for the treatment of postoperative complications after hepatobiliary, pancreatic and thoracic surgery. Endoscopic decompression of the biliary tract is the treatment of choice for biliary duct leakage after cholecystectomy, hepatic resection or liver transplantation. Postoperative biliary duct stenosis can also be successfully treated by endoscopic balloon dilatation and implantation of various endoprostheses in most of the patients. In the case of pancreatic fistulas, especially those occurring after central or distal pancreatic resections, endoscopic decompression of the pancreatic duct can significantly contribute to rapid healing. Additionally, interventional endosonography provides a valuable treatment option for transgastric drainage of postoperative fluid collections, which often accompany a pancreatic fistula. Various treatment alternatives have been described for the bronchoscopic treatment of bronchopleural and tracheoesophageal fistulas, which often lead to the rapid alleviation of symptoms and often to the definitive closure of the fistula.
Collapse
Affiliation(s)
- Konstantinos Kouladouros
- Zentrale Interdisziplinäre Endoskopie, Chirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Georg Kähler
- Zentrale Interdisziplinäre Endoskopie, Chirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| |
Collapse
|
2
|
S S, I T, H K. Endoscopic treatment of bronchopleural fistula using ethyl-2-cyanoacrylate: A report of two cases. Respir Med Case Rep 2020; 30:101123. [PMID: 32577364 PMCID: PMC7303975 DOI: 10.1016/j.rmcr.2020.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a serious complication after lung resection or chronic empyema. BPF often causes severe pneumonia or fatal airway bleeding due to bronchoarterial fistula. Although BPF often requires surgical treatment, another, more conservative treatment option is endoscopic bronchial occlusion for non-operable patients. Many endoscopic treatments have been reported. We report here two patients with BPF who underwent endoscopic bronchial occlusion. Patient 1 had postoperative BPF with empyema and Patient 2 had BPF due to chronic empyema. Because the BPF in Patient 1 was small, it could be successfully treated by endobronchial occlusion using only ethyl-2-cyanoacrylate. In contrast, because the BPF in Patient 2 was large, it could not be treated by endobronchial occlusion using ethyl-2-cyanoacrylate alone; it was successfully treated by endobronchial occlusion using the combination of ethyl-2-cyanoacrylate and a silicone spigot (endobronchial Watanabe spigot, EWS). When we attempt endoscopic bronchial occlusion with BPF for non-operable patients, ethyl-2-cyanoacrylate may be an option for small fistulas, while the combination of EWS and ethyl-2-cyanoacrylate may be suitable for large fistulas.
Collapse
Affiliation(s)
- Shigeki S
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Tomohiro I
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kenichi H
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| |
Collapse
|
3
|
Rivo E, Quiroga J, García-Prim JM, Obeso A, Soro J, Oseira A, Golpe A. Bronchoscopic sclerosis of post-resectional bronchial fistulas. Asian Cardiovasc Thorac Ann 2018; 27:93-97. [PMID: 30525867 DOI: 10.1177/0218492318818965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.
Collapse
Affiliation(s)
- Eduardo Rivo
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Jorge Quiroga
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - José-María García-Prim
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Andrés Obeso
- 3 Thoracic Surgery Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jose Soro
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Anaí Oseira
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Antonio Golpe
- 2 Pulmonology Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| |
Collapse
|
4
|
Endoscopic sealing of bronchopleural fistulas with submucosal injection of a tissue expander: a novel technique. Can Respir J 2011; 17:e23-4. [PMID: 20186363 DOI: 10.1155/2010/385036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The occurrence of a bronchopleural fistula (BPF) continues to represent a challenging management problem, and is associated with high morbidity and mortality. A novel and successful technique that uses submucosal injection of a tissue expander for bronchoscopic occlusion of BPFs has been designed. This method may be used either alone or in combination with bronchoscopic instillation of n-butyl-cyanoacrylate glue. The occlusion technique is described, with a presentation of two patients who were successfully treated with this method. The submucosal injection of a tissue expander is an effective, economical and minimally invasive technique for managing BPFs.
Collapse
|
5
|
Mora G, de Pablo A, García-Gallo CL, Laporta R, Ussetti P, Gámez P, Córdoba M, Varela A, Ferreiro MJ. [Is endoscopic treatment of bronchopleural fistula useful?]. Arch Bronconeumol 2007; 42:394-8. [PMID: 16948992 DOI: 10.1016/s1579-2129(06)60553-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas. MATERIAL AND METHODS We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope. RESULTS Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary. CONCLUSIONS The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
Collapse
Affiliation(s)
- Gemma Mora
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, España.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Mora G, de Pablo A, García-Gallo CL, Laporta R, Ussetti P, Gámez P, Córdoba M, Varela A, Ferreiro MJ. ¿Es útil el tratamiento endoscópico de las fístulas bronquiales? Arch Bronconeumol 2006. [DOI: 10.1157/13091648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
7
|
Seymour CW, Krimsky WS, Sager J, Kruklitis RJ, Lund ME, Musani AI, Sterman DH. Transbronchial Needle Injection: A Systematic Review of a New Diagnostic and Therapeutic Paradigm. Respiration 2006; 73:78-89. [PMID: 16498271 DOI: 10.1159/000090994] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/20/2005] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Transbronchial needle catheters are commonly used during flexible and rigid bronchoscopy for needle aspiration. The use of these catheters can be expanded by employing the technique of transbronchial needle injection. METHODS AND RESULTS By injecting lesions in the airways, peribronchial structures, mediastinum, or lung parenchyma, transbronchial needle injection has been applied to the treatment of lung cancer, inflammatory disorders of the airways, recurrent respiratory papillomatosis, as well as bronchopleural fistulas. Diagnostic applications have included the localization of peripheral lung nodules as well as sentinel lymph nodes. CONCLUSIONS Our review defines this bronchoscopic technique and summarizes its various reported applications.
Collapse
Affiliation(s)
- Christopher W Seymour
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Gil Navarro MV, Marín Gil R, Martín Juan J, Alvarez del Vayo C. Eficacia de ácido tricloroacético en fístula broncopleural. FARMACIA HOSPITALARIA 2006; 30:59-60. [PMID: 16569186 DOI: 10.1016/s1130-6343(06)73945-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
9
|
Nakagawa M, Seki M, Koike J, Kanai T. Gastric tube-to-pleural fistula seventeen months after esophagectomy: successful endoscopic treatment of an unusual complication. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2005; 53:569-72. [PMID: 16279590 DOI: 10.1007/s11748-005-0070-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A gastric tube-to-pleural fistula is an uncommon late complication of esophagectomy. In this report, a 71-year-old man who developed gastric tube-to-pleural fistula 17 months after esophagectomy with intrathoracic reconstruction using a gastric tube is presented. Chest radiograph on admission showed massive right pleural effusion, which demonstrated empyema on chest drainage. Further imaging studies confirmed a gastric tube-to-pleural fistula that had no connection to the airway. We chose endoscopic intervention as a less invasive procedure and successfully treated the patient by plugging fibrin glue into the fistula under endoscopy. Review of the literature and discussion of the clinical features, differential causes, and treatment options of this rare and severe condition are presented.
Collapse
|
10
|
Mara C, Sarrot-Reynauld F, Ferretti G, Raclot-Roy N, Massot C, Brichon PY. Une complication rare d’un carcinome bronchique. Rev Med Interne 2004; 25:528-9. [PMID: 15219372 DOI: 10.1016/j.revmed.2003.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 10/13/2003] [Indexed: 10/26/2022]
Affiliation(s)
- C Mara
- Service de médecine interne, département pluridisciplinaire de médecine, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France
| | | | | | | | | | | |
Collapse
|
11
|
Sai K, Ishibashi Y, Oota N, Muto S, Kitamura T, Takara Y, Kido M, Nangaku M, Nakao A, Fujita T. Treatment of Subcutaneous Dialysate Leak with Polidocanol: Case Report. Perit Dial Int 2004. [DOI: 10.1177/089686080402400120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- K. Sai
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - Y. Ishibashi
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - N. Oota
- Division of Urology University of Tokyo School of Medicine Tokyo, Japan
| | - S. Muto
- Division of Urology University of Tokyo School of Medicine Tokyo, Japan
| | - T. Kitamura
- Division of Urology University of Tokyo School of Medicine Tokyo, Japan
| | - Y. Takara
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - M. Kido
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - M. Nangaku
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - A. Nakao
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| | - T. Fujita
- Division of Nephrology and Endocrinology University of Tokyo School of Medicine Tokyo, Japan
| |
Collapse
|