Comparing Bronchoscopic Sealing with Absolute Alcohol, Silver Nitrate and Methylene Blue to Traditional Surgical Approaches in the Management of Persistent Bronchopleural Fistula

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Background : Persistent Bronchopleural Fistula (BPF) is a challenging complication of various pulmonary diseases and surgery.Traditional surgical approaches have been the mainstay of treatment, but bronchoscopic interventions have gained popularity as less invasive alternatives.This study aims to evaluate the efficacy of bronchoscopic sealing of persistent BPF using absolute alcohol or silver nitrate in a cohort of 120 cases over a 13-year period. Aims and Objectives :The primary objective of this study was to assess the success rate of bronchoscopic sealing in closing persistent BPFs using absolute alcohol or silver nitrate.Secondary objectives included evaluating the safety and feasibility of the procedure and identifying factors associated with treatment success. Materials and Methods :A retrospective analysis was conducted on 120 consecutive cases of persistent BPF treated bronchoscopically using absolute alcohol and silver nitrate.Patient demographics, underlying pulmonary conditions, fistula characteristics, procedural details and outcomes were reviewed.The bronchoscopic sealing technique involved direct instillation of absolute alcohol or silver nitrate application to the fistula site.Results : Out of the 120 cases, successful bronchoscopic sealing of persistent BPF was achieved in 114 cases, resulting in a remarkable success rate of 95%.The mean age of the patients was 45 years, with a male predominance.Underlying pulmonary conditions included postoperative BPF (n=4), necrotizing pneumonia (n=25), empyema (n=20), and traumatic injury (n=15), secondary pneumothorax (n=50).Complications were minimal, including mild bronchospasm in two cases and transient fever in three cases.Conclusion : Bronchoscopic sealing with absolute alcohol or silver nitrate is a highly effective and safe technique for treating persistent BPF.This study demonstrates a remarkable success rate of 95% in closing BPFs using this approach.Bronchoscopic intervention should be considered as a first-line treatment option in selected cases, providing a less invasive alternative to surgery.Further prospective studies are warranted to validate these findings and refine the bronchoscopic sealing technique for optimal outcomes.

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