Endoscopic treatment of bronchopleural fistula using trichloroacetic acid

INTRODUCTION: A bronchopleural fistula (BPF) is a communication between the pleural space and a main or lobar bronchus. BPFs are rare, occurring typically after major lung resection and are associated with high mortality and morbidity. Therapeutic options include surgical and bronchoscopic procedures, which depend on patient status, location and size of the fistula. There are several BPF sealants but none is considered gold standard. Endoschopic treatment with trichloroacetic acid (TCA) leads to closure of BPF through its irritating properties. AIM AND OBJECTIVES: The aim of this study was to understand if the instillation of TCA through a bronchoscopic procedure could be useful in closing BPFs. METHODS: Records of all patients treated for BPF with TCA in our Pulmonology Department between 2011 and 2015 were reviewed. Under local anesthesia patients were submitted to a bronchoscopy where BPFs were confimed and 50% TCA solution was instilled through a flexible tube into the fistula. RESULTS: We identified 3 male patients with a mean age of 62,7yrs. All fistulae occurred as postoperative complications (two after left pneumectomy and one after right lower bilobectomy). BPF size ranged between 1 to 3 mm. Two were located at the left main bronchus and the other at the right main bronchus. The mean number of treatments was 2,7/patient. One BPF was resolved after the procedure. Of the other two patients, none had status performance to proceed to corrective surgery. CONCLUSIONS: In our experience bronchoscopic treatment of BPF with TCA could be effective in selected patients. Further research is needed to understand which are the best endoschopic procedures, especially in patients that aren´t fit for surgery.