title: Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae.
abstract: 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 (<or=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Critical Care and Respiratory Division, University of Athens, Athens, Greece.
authors.forename: Grigoris
authors.initials: G
authors.lastname: Stratakos
authors.forename: Lina
authors.initials: L
authors.lastname: Zuccatosta
authors.forename: Ilias
authors.initials: I
authors.lastname: Porfyridis
authors.forename: Michele
authors.initials: M
authors.lastname: Sediari
authors.forename: Charalambos
authors.initials: C
authors.lastname: Zisis
authors.forename: Vasso
authors.initials: V
authors.lastname: Mariatou
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Kostopoulos
authors.forename: Argini
authors.initials: A
authors.lastname: Psevdi
authors.forename: Spyros
authors.initials: S
authors.lastname: Zakynthinos
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000188:drug therapy* / Q000209:etiology; D001999:Bronchoscopy / Q000379:methods*; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000188:drug therapy* / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects; D012008:Recurrence; D012835:Silver Nitrate / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012835:Silver Nitrate