Endobronchial identification of persistent peripheral bronchopleural fistula with digital chest tube monitoring followed by treatment with endobronchial one-way valve implantation

Introduction: Bronchopleural fistula (BPF) is associated with high morbidity and mortality and causes prolonged hospital stay and costs. Surgery remains the treatment of choice, however, many patients are at high risk or unwilling to undergo thoracotomy. Objectives: To present a standardized approach of endoscopic diagnosis and treatment of persistent peripheral BPF. Methods: 10 patients with persistent air leaks (presence of chest tube >7 days) underwent bronchoscopy with balloon occlusion technique and digital monitoring of airflow in order to identify the peripheral source of bronchopleural fistula. Endobronchial one-way valve implantation (Spiration Inc., Olympus) was performed on a segmental or subsegmental level to block ventilation to the BPF. Results: Mean chest tube drainage time prior to the intervention was 22±13 days. The source of the BPF was endoscopically identified in all cases. Bronchoscopic valve implantation (1.6±0.8 valves per patient) was performed successfully in all patients. Using digital chest tube monitoring air flow immediately decreased from 1026±695ml/min to 56±71ml/min (p < 0,001), indicating successful cessation of the leakage. 2 patients underwent additional chemical pleurodesis. The chest tube was removed 8±5 days after bronchoscopy. There was no evidence of recurrence during a mean follow-up time of 2 months. Conclusion: Using a standardized approach in endobronchial diagnosis followed by endobronchial one-way valve implantation results in a high responder rate in patients with peripheral BPF.