An innovative solution for prolonged air leaks: The customized endobronchial silicone blocker

Background: Prolonged air leak (PAL) is a life threatening condition & can be due to broncho-pleural fistula (BPF) or alveolar-pleural fistula (APF). Though numerous bronchoscopic & surgical treatments are described, they have limited data & success, with accessibility and economic issues for some devices such as endobronchial valves in some parts of world. We describe a new, safe & effective customized endobronchial silicone blocker (CESB) for the treatment of PAL. Methods: 30 patients with PAL who failed conventional measures including surgery, or were not surgical candidates were considered. Leak localization was done using a balloon occlusion test. The CESB was formed by molding silicone stent pieces into a conical shape. The CESB was introduced through the rigid bronchoscope into the culprit segment & re-inforced with bio-glue to prevent migration (Fig I). Following this, the CESB was removed after 6 weeks, facilitated by a special bucket handle stitch. Results: 48 CESB’s were placed in 30 patients (24 males, 6 females) with mean age of 51 ± 19 years. The PAL’s included APF -16 & BPF -14. The average diameter of the CESB used was 7.8 ± 3 mms. PAL’s resolved in 25/30 patients (83.3%). Migration was observed in 5 patients. Pleurodesis was done in 13 of 16 patients with APF. No other complications were observed. Conclusion: CESB’s represent a safe & effective innovative option in the management of PAL. They are to be considered in patients who are not surgical candidates, fail surgery, or occur after surgery.