Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae

Stratakos, Grigoris; Zuccatosta, Lina; Porfyridis, Ilias; Sediari, Michele; Zisis, Charalambos; Mariatou, Vasso; Kostopoulos, Eleftherios; Psevdi, Argini; Zakynthinos, Spyros; Gasparini, Stefano

doi:10.1016/j.jtcvs.2008.10.054

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 603-607, September 2009

Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae

Grigoris Stratakos, MD
- Critical Care and Respiratory Division, University of Athens, Athens, Greece
Lina Zuccatosta, MD
- Pulmonary Diseases Unit, Department of Internal Medicine, Immunoallergic and Respiratory diseases, “Ospedali Riuniti,” Ancona, Italy
Ilias Porfyridis, MD
- Critical Care and Respiratory Division, University of Athens, Athens, Greece
Michele Sediari, MD
- Pulmonary Diseases Unit, Department of Internal Medicine, Immunoallergic and Respiratory diseases, “Ospedali Riuniti,” Ancona, Italy
Charalambos Zisis, MD, FETCS
- Thoracic Surgery Department, “Evaggelismos” Hospital, Athens, Greece
- Address for reprints: Charalambos Zisis, MD, FETCS, Department of Thoracic Surgery, “Evangelismos” Hospital 45-47, Ipsilantou St, 106 75 Athens, Greece.
Vasso Mariatou, MD
- Critical Care and Respiratory Division, University of Athens, Athens, Greece
Eleftherios Kostopoulos, MD
- Anesthesiology Department, “Evaggelismos” Hospital, Athens, Greece
Argini Psevdi, MD
- Anesthesiology Department, “Evaggelismos” Hospital, Athens, Greece
Spyros Zakynthinos, MD
- Critical Care and Respiratory Division, University of Athens, Athens, Greece
Stefano Gasparini, MD
- Pulmonary Diseases Unit, Department of Internal Medicine, Immunoallergic and Respiratory diseases, “Ospedali Riuniti,” Ancona, Italy

Received 17 July 2008; received in revised form 20 September 2008; accepted 26 October 2008. published online 23 February 2009.

Objective

Bronchopleural fistula is a severe complication after pneumonectomy or lobectomy. Local application of silver nitrate to seal bronchopleural fistulae was reported once 25 years ago with considerable success but was never repeated. We aimed to develop and evaluate a concrete technique of applying silver nitrate through a flexible bronchoscope to treat bronchopleural fistulae in central airways.

Methods

Consecutive patients with small (≤5 mm) bronchopleural fistulae in proximal airways were included in the study. After measurement of bronchopleural fistula size through a flexible videobronchoscopy, a standard bronchoscopic cytology brush covered with silver nitrate was passed through the working channel of the scope and was rubbed against the fistula's orifice producing blanching and edema on the mucosa. This procedure was repeated until closure of the fistula's orifice (treatment success) or absence of any tissue response after 2 bronchoscopic sessions (treatment failure).

Results

Of 16 patients referred, 5 were excluded from treatment because of large (>5 mm) fistulae. Among the 11 treated patients (median fistula diameter 3 mm, range 2–5 mm), treatment failure was observed in 2 patients in whom treatment was attempted early (15 days postsurgery). In the remaining 9 patients, treatment success was achieved (81.8% success rate) after a median of 2.5 (range 1–10) applications of silver nitrate. After 11 (0.5–24) months of follow-up, no relapse was observed among successfully treated fistulae.

Conclusion

The local application of silver nitrate through a flexible bronchoscopic brush produced a burn and healing process on the mucosa of small bronchopleural fistulae of the central airways, leading to effective and lasting treatment in most cases.

Abbreviation and Acronym: BPF, bronchopleural fistula

CTSNet classification: 11, 15