Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae.
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.
Stratakos
Grigoris
G
Critical Care and Respiratory Division, University of Athens, Athens, Greece.
Zuccatosta
Lina
L
Porfyridis
Ilias
I
Sediari
Michele
M
Zisis
Charalambos
C
Mariatou
Vasso
V
Kostopoulos
Eleftherios
E
Psevdi
Argini
A
Zakynthinos
Spyros
S
Gasparini
Stefano
S
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
D012835:Silver Nitrate