Bronchoscopic Closure of Bronchopleural Fistula Using Gelfoam Versus Autologous Blood

Abstract
Background: Diagnosis and management of bronchopleu-ral fistula remains a major therapeutic challenge for physicians, since it is medical diagnosis and localization may be trouble-some and needs various imaging techniques, likewise it is associated with a significant morbidity and fatality so fruitful bronchoscopic management is considered a perfect choice as it is less invasive procedure especially in patients who are unsuitable for surgery and standard anesthesia or associated with comorbidities, additionally it would lessen cost and lifelong hospital stay.
Aim of the Study: To compare efficacy of gelfoam and autologous blood injection in bronchoscopic closure of bron-chopleural fistula.
Subjects and Methods: This study carried out at Fibrooptic Bronchoscopy Unit in Chest Department, Al-Hussein Hospital, Al-Azhar University in the period between October 2015 to October 2017. One setting of fibrooptic bronchoscopic closure trial was performed in forty patients with bronchopleural fistula using gelfoam injection in twenty patients (Group A) and autologous blood in another twenty patients (Group B) after full clinical and investigational assessment.
Results: Successful closure occurred in 19 patients (95%) in (group A) using gelfoam and in 18 patients (90%) in (group B) using autologous blood, the mean hospitalization time was 7.05 days in (group A) and 9.35 days in (group B) the mean time from procedure to chest tube removal was 3.2 days in (group A) and 5.75 days in (group B) also the mean time from procedure to discharge was 3.8 days in (group A) and 6.5 days in (group B) pneumothorax and death did not occur in both groups but hemoptysis occurred in 5 patients (25%) in (group A), and 7 patients (35%) in (group B) also cough occurred in 16 patients (80%) in (group A), and 18 patients (90%) in (group B) and low grade fever occurred in 12 patients (60%) in (group A) and 15 patients (75%) in (group B).
Conclusion: Bronchoscopic closure of bronchopleural fistula utilizing gelfoam or autologous blood is a straightforward procedure which can be performed safely and securely under local anesthesia with promising outcomes, it is ought to be viewed an as an ideal choice particularly in small sized fistulae in patients who are unfit for surgery and general anesthesia.