Clinical evaluation of endoscopic bronchial closure of central airway-pleural fistulas with the atrial septal defect occluders: long-term follow-up_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TAN Jianlong , CHEN Fengyu , OUYANG Bin , ZHANG Weidong , DENG Hongying , LI Rong , PENG Ran ,  LIU Zhiguang

Department of Respiratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P. R. China;

Corresponding?author：

LIU Zhiguang, Email: liuzhiguang0404@163.com

Keywords：

Bronchopleural fistula; bronchoscopy; atrial septal defect occluder

DOI：

10.7507/1671-6205.202204024

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Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.

Citation： TAN Jianlong, CHEN Fengyu, OUYANG Bin, ZHANG Weidong, DENG Hongying, LI Rong, PENG Ran, LIU Zhiguang. Clinical evaluation of endoscopic bronchial closure of central airway-pleural fistulas with the atrial septal defect occluders: long-term follow-up. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(6): 403-407. doi: 10.7507/1671-6205.202204024 Copy

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10.	Fruchter O, El Raouf BA, Abdel Rahman N, et al. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up. Respiration, 2014, 87(3): 227-233.
11.	劉家杰, 肖澤林, 高健齊, 等. 應用房間隔缺損封堵器封堵結核性支氣管胸膜瘺的療效分析. 嶺南現代臨床外科, 2020, 20(5): 582-587.
12.	Bai Y, Li YS, Chi J, et al. Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series. BMC Pulm Med, 2021, 21(1): 313.
13.	胡軼, 尹雯, 張衛明, 等. 應用房/室間隔缺損封堵器治療支氣管胸膜瘺的臨床療效評價. 華中科技大學學報(醫學版), 2019, 48(6): 690-694.
14.	周金花, 劉歡, 邊翠霞, 等. 房間隔缺損封堵器治療肺癌術后支氣管胸膜瘺一例. 中國呼吸與危重監護雜志, 2021, 20(10): 741-742.

1. Marques P, Andrade G, Granadas J, et al. Iatrogenic bronchopleural fistula. Cureus, 2020, 12(12): e12187.
2. 陳偉莊, 吳宏成. 獲得性氣道瘺的治療進展. 現代實用醫學, 2022, 34(1): 6-8,43.
3. Nagahiro I, Aoe M, Sano Y, et al. Bronchopleural fistula after lobectomy for lung cancer. Asian Cardiovasc Thorac Ann, 2007, 15(1): 45-48.
4. Motus IY, Bazhenov AV, Basyrov RT, et al. Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward? Interact Cardiovasc Thorac Surg, 2020, 30(2): 249-254.
5. Scordamaglio PR, Tedde ML, Minamoto H, et al. Endoscopic treatment of tracheobronchial tree fistulas using atrial septal defect occluders: preliminary results. J Bras Pneumol, 2009, 35(11): 1156-1160.
6. 北京健康促進會呼吸及腫瘤介入診療聯盟專家委員會. 繼發性氣道–消化道瘺介入診治專家共識. 中華肺部疾病雜志(電子版), 2018, 11(2): 131-138.
7. 勞妙嬋, 高興林, 李靜, 等. 獲得性呼吸道瘺的介入治療進展. 中華結核和呼吸雜志, 2016, 39(3): 221-223.
8. 王湘奇, 黃海東, 張偉, 等. 不同類型先天性心臟病封堵器在支氣管胸膜瘺中的應用. 中國呼吸與危重監護雜志, 2021, 20(1): 37-41.
9. 鐘志成, 高興林, 陳娉娉, 等. 經支氣管鏡置入房間隔封堵器治療支氣管胸膜瘺二例. 中華結核和呼吸雜志, 2018, 41(2): 153-155.
10. Fruchter O, El Raouf BA, Abdel Rahman N, et al. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up. Respiration, 2014, 87(3): 227-233.
11. 劉家杰, 肖澤林, 高健齊, 等. 應用房間隔缺損封堵器封堵結核性支氣管胸膜瘺的療效分析. 嶺南現代臨床外科, 2020, 20(5): 582-587.
12. Bai Y, Li YS, Chi J, et al. Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series. BMC Pulm Med, 2021, 21(1): 313.
13. 胡軼, 尹雯, 張衛明, 等. 應用房/室間隔缺損封堵器治療支氣管胸膜瘺的臨床療效評價. 華中科技大學學報(醫學版), 2019, 48(6): 690-694.
14. 周金花, 劉歡, 邊翠霞, 等. 房間隔缺損封堵器治療肺癌術后支氣管胸膜瘺一例. 中國呼吸與危重監護雜志, 2021, 20(10): 741-742.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical evaluation of endoscopic bronchial closure of central airway-pleural fistulas with the atrial septal defect occluders: long-term follow-up

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