What is the key question?

• What is the current experience with customized endobronchial silicone blocker (CESB) for the treatment of persistent air leak (PAL)?

What is the bottom line?

• PALs can be secondary to an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). PALs can cause significant morbidity and mortality.
• Conventional treatment options include conservative management and surgery. Limited options exist for patients who are poor surgical candidates; Bronchoscopic methods emerged as potential options (such as endobronchial instillation of sealants for BPF and endobronchial valves for APF) but have variable degrees of success and can be expensive and not widely available in developing countries.
• This retrospective study reviewed 49 CESBs placed in 31 patients with PALs. CESBs were designed by molding silicone stent pieces into a conical shape, deployed with rigid bronchoscopy into the appropriate segment, and reinforced with cyanoacrylate glue to prevent migration. In patients with APF, pleurodesis was performed after leak resolution to prevent recurrence. Following this, the CESB was removed after 6 weeks.
• The PALs included APF (n=16), bronchopleural fistula (n=14), and airway-mediastinal fistula (n=1). The average diameter of the CESB used was 7.9±2.9mm. There was resolution of the PAL in 26 of 31 patients (84%). Pleurodesis was performed in 13 of 16 patients with APF to prevent recurrence. The CESB migrated in 5 patients with no adverse events. No other significant complications were observed.

Why read on?

• The authors discuss their positive experience (safety and efficacy) with the use of CESB for the treatment of PALs in patients who are not surgical candidates, fail surgery, or developed recurrence following surgery.