Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Bronchoscopic Ethanolamine Injection Therapy in Patients with Persistent Air Leak from Chest Tube Drainage

  • Lim, Ah-Leum (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Cheol-Hong (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Hwang, Yong-Il (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Chang-Youl (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Choi, Jeong-Hee (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Shin, Tae-Rim (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Yong-Bum (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Jang, Seung-Hun (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Sang-Myeon (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Dong-Gyu (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Myung-Goo (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Hyun, In-Gyu (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Jung, Ki-Suck (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Shin, Ho-Seung (Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine)
  • Received : 2012.01.19
  • Accepted : 2012.04.14
  • Published : 2012.05.30
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Abstract

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

Keywords

References

  1. Baumann MH, Strange C. The clinician's perspective on pneumothorax management. Chest 1997;112:822-8. https://doi.org/10.1378/chest.112.3.822
  2. Baumann WR, Ulmer JL, Ambrose PG, Garvey MJ, Jones DT. Closure of a bronchopleural fistula using decalcified human spongiosa and a fibrin sealant. Ann Thorac Surg 1997;64:230-3. https://doi.org/10.1016/S0003-4975(97)00282-8
  3. Jessen C, Sharma P. Use of fibrin glue in thoracic surgery. Ann Thorac Surg 1985;39:521-4. https://doi.org/10.1016/S0003-4975(10)61991-1
  4. Roksvaag H, Skalleberg L, Nordberg C, Solheim K, Hoivik B. Endoscopic closure of bronchial fistula. Thorax 1983;38:696-7. https://doi.org/10.1136/thx.38.9.696
  5. Asaki S. Tissue solidification in coping with digestive tract bleeding: hemostatic effect of local injection of 99.5% ethanol. Tohoku J Exp Med 1981;134:223-7. https://doi.org/10.1620/tjem.134.223
  6. Fujisawa T, Hongo H, Yamaguchi Y, Shiba M, Kadoyama C, Kawano Y, et al. Intratumoral ethanol injection for malignant tracheobronchial lesions: a new bronchofiberscopic procedure. Endoscopy 1986;18: 188-91. https://doi.org/10.1055/s-2007-1018369
  7. Otani T, Tatsuka T, Kanamaru K, Okuda S. Intramural injection of ethanol under direct vision for the treatment of protuberant lesions of the stomach. Gastroenterology 1975;69:123-9.
  8. Light RW. Management of spontaneous pneumothorax. Am Rev Respir Dis 1993;148:245-8. https://doi.org/10.1164/ajrccm/148.1.245
  9. Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med 2002;165:1240-4. https://doi.org/10.1164/rccm.200111-078OC
  10. van de Brekel JA, Duurkens VA, Vanderschueren RG. Pneumothorax: results of thoracoscopy and pleurodesis with talc poudrage and thoracotomy. Chest 1993; 103:345-7. https://doi.org/10.1378/chest.103.2.345
  11. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590-602. https://doi.org/10.1378/chest.119.2.590
  12. Berger R. Pleurodesis for spontaneous pneumothorax. Will the procedure of choice please stand up? Chest 1994;106:992-4. https://doi.org/10.1378/chest.106.4.992
  13. Colt HG, Russack V, Chiu Y, Konopka RG, Chiles PG, Pedersen CA, et al. A comparison of thoracoscopic talc insufflation, slurry, and mechanical abrasion pleurodesis. Chest 1997;111:442-8. https://doi.org/10.1378/chest.111.2.442
  14. Light RW, O'Hara VS, Moritz TE, McElhinney AJ, Butz R, Haakenson CM, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study. JAMA 1990;264:2224-30. https://doi.org/10.1001/jama.1990.03450170072025
  15. Takaoka K, Inoue S, Ohira S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 2002;122:374-8. https://doi.org/10.1378/chest.122.1.374
  16. Hollaus PH, Lax F, el-Nashef BB, Hauck HH, Lucciarini P, Pridun NS. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997;63:1391-6. https://doi.org/10.1016/S0003-4975(97)00409-8
  17. Ando M, Yamamoto M, Kitagawa C, Kumazawa A, Sato M, Shima K, et al. Autologous blood-patch pleurodesis for secondary spontaneous pneumothorax with persistent air leak. Respir Med 1999;93:432-4. https://doi.org/10.1053/rmed.1999.0567

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