Endoscopic management of bronchopleural fistulas

Abstract

A bronchopleural fistula (BPF) is an abnormal communication between the airway and the pleural space. It most commonly occurs after pulmonary resection but may be a result of multiple benign and malignant diseases. Patients with BPFs may present with a variety of symptoms, but they typically include fatigue, cough, dyspnea, and/or purulent sputum. In the acute setting, symptoms may be life threatening as a tension pneumothorax can develop. Bronchopleural fistulas may be treated surgically or semi-invasively using endoscopic techniques. Endoscopic therapies for closure of a BPF include various sealants and glues, one-way endobronchial valves, and airway stents to cover the defect. Although there is a general consensus that endoscopic therapies are safe and well tolerated in a majority of patients, there are no large series or randomized trials exploring specific therapies or patient outcomes. The choice of therapy (endoscopic vs. surgical) is highly dependent on individual patient situation and physician preference. These techniques are not mutually exclusive, and combination therapies should be explored.