title: Clinical evaluation of endoscopic bronchial occlusion with silicone spigots for the management of persistent pulmonary air leaks.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical effectiveness of endoscopic bronchial occlusion (EBO) with endobronchial Watanabe spigots (EWSs), a type of silicone bronchial blocker, for managing prolonged pulmonary air leaks.
  
  
  METHODS
  Between October 2002 and April 2010, 24 patients with surgically incurable pulmonary air leaks underwent EBO with EWSs. The spigot was grasped with forceps and inserted into the affected bronchus by using a flexible bronchoscope through an endotracheal or a tracheostomy tube.
  
  
  RESULTS
  In each patient, at least one EWS (mean=2.8) was placed for air leaks due to pneumothorax (n=15), empyema (n=8), or postsurgical complications (n=1). Twelve patients (50%) had complete resolution of the air leaks and seven (29.2%) had a reduction in air leaks, but five (20.8%) showed no improvement. Twenty-three patients required thoracic drainage tubes, which were successfully removed after EBO in 15 patients (65.2%). Of the 24 patients, four experienced severe respiratory failure requiring mechanical ventilation but were successfully treated. Complications were spigot migration, atelectasis, pneumonia, and lung abscess, but none caused significant mortality.
  
  
  CONCLUSIONS
  EBO with EWSs seems to be a reasonable and manageable treatment option for patients with prolonged pulmonary air leaks, including those with severe respiratory failure requiring mechanical ventilation.
authors.affiliation: Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan. sasastaf@hotmail.co.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Tamura
authors.forename: Ya-Shu
authors.initials: YS
authors.lastname: Chang
authors.forename: Norio
authors.initials: N
authors.lastname: Okamoto
authors.forename: Yuka
authors.initials: Y
authors.lastname: Matsuura
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tamiya
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Nobuko
authors.initials: N
authors.lastname: Uehara
authors.forename: Masashi
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hirashima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawase
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016084:Bronchoconstriction; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D012828:Silicones; D016896:Treatment Outcome
chemical_list: D012828:Silicones