Efficacy and safety of endobronchial spigot for the management of postoperative fistula, refractory pneumothorax, and hemoptysis: A single-center retrospective study.

BACKGROUND: Bronchopleural fistula, refractory pneumothorax, and massive hemoptysis pose significant clinical challenges. Endobronchial spigot offers a less invasive alternative to surgical interventions for the management of these conditions. This study aimed to evaluate the efficacy and safety of endobronchial spigot in patients with bronchopleural fistula, refractory pneumothorax, and hemoptysis in whom interventional radiology or surgical intervention was not feasible.

METHODS: Endobronchial spigot procedures performed at the Japanese Red Cross Medical Center between December 2017 and January 2024 were retrospectively analyzed. Patient demographics, procedural details, methods of target bronchus identification, additional treatments, clinical outcomes, and complications were included in the analysis.

RESULTS: A total of 27 procedures were performed in 20 patients, including 16 patients with intractable pneumothorax, 2 with postoperative fistula, and 2 with hemoptysis. The responsible bronchi were identified using balloon occlusion, endobronchial injection of a contrast medium under fluoroscopic guidance, and intrathoracic injection of indigo carmine via thoracic tubes. Of the 20 patients, 15 (75 %) achieved clinical improvements: postoperative fistula 1/2 (50 %), refractory pneumothorax 12/16 (75 %), and hemoptysis 2/2 (100 %). Procedure-related complications, such as endobronchial spigot migration (3 patients) and mediastinal and intra-abdominal emphysema (1 patient), were resolved with conservative managements.

CONCLUSIONS: Endobronchial spigot might be a valuable therapeutic option for treating intractable pneumothorax, postoperative fistula, and hemoptysis.