Towards quick and easy bronchial occlusion with silicon spigots: A new technique using guide sheath and curette

BACKGROUND: Bronchial occlusion (BO) using silicon spigots (SSs) has been reported to be effective for intractable bronchopleural fistula. Here, a new BO method using a guide sheath (GS) and curette was devised. OBJECTIVES: To evaluate the usefulness of BO using a GS and curette. METHODS: The study enrolled 12 consecutive patients who underwent BO (under mild sedation) between October 2014 and January 2016. The devices used were an 1T-260 bronchoscope, and an SG-201C GS, which was customized by cutting it 30 mm from the proximal end to make it compatible with a CC-4CR-1 curette (all Olympus Ltd., Tokyo, Japan). The SS attached to the curette tip was inserted into the target bronchus. Then, the SS was left in position by pulling the curette back through the GS, while holding the SS with the GS. The success rate and procedural time were investigated. RESULTS: BO with SSs was performed on 74 target bronchi (3 to 9 bronchi/patient). The success rate of target BO was 97.3%(72/74). The required time for BO per SS ranged from 5.0 to 12.3 (mean 7.3) min. This method enabled easy insertion of the SS, even in the upper lobe bronchus, in which it was difficult to completely insert the bronchoscope tip, and the SSs were clearly visible during placement. No complications were observed. CONCLUSIONS: BO using a GS and curette was a useful technique, in particular, when approaching the upper lobe bronchus.