Bronchoscopic Treatment of Giant Emphysematous Bullae with Endobronchial Silicone Plugs

Abstract

Purpose

Surgical bullectomy is the standard treatment of giant emphysematous bulla (GEB). However, bronchoscopic treatment should be considered as an alternative approach for patients who are unfit for surgical treatment. The study aimed to evaluate the clinical efficacy of endobronchial occlusion for the treatment of GEB using silicone plugs.

Methods

This retrospective study recruited four patients with GEB who were unsuitable for surgery. Preoperative planning was performed using high-resolution computed tomography and a virtual bronchoscopic navigation system. Customized silicone plugs were then placed in the target airway via bronchoscopy to cause GEB regression and atelectasis.

Results

All procedures were completed successfully in four patients. Three months after the procedures, compared with baseline, increases in the mean forced expiratory volume in 1 s (from 1.20 L/s to 1.33 L/s), forced vital capacity (from 2.63 L to 2.90 L), diffusion lung capacity for carbon monoxide (from 29% to 41% of the predicted value) and 6-minute walking test (from 412 m to 474 m) were observed. Additionally, the mean total lung capacity (from 6.80 L to 6.35 L), residual volume (from 3.97 L to 3.52 L), and St. George’s Respiratory Questionnaire scores (from 67 to 45) were all lower than baseline data.

Conclusion

Our preliminary results demonstrated that the endobronchial placement of silicone plugs could be a low-cost, safe, and effective choice for the treatment of GEB in surgically unfit patients.

Keywords:

• giant bulla
• bronchoscopy
• silicone spigot
• endobronchial occlusion

Ethics Approval and Informed Consent

The study was performed in accordance with the principles stated in the declaration of Helsinki and approved by the Second Affiliated Hospital of Fujian Medical University Ethics Committee (number FYFE2021-51). The authors confirm that all participants provide written informed consent and give their consents for images and all other clinical information to be published.

Acknowledgments

We gratefully acknowledge the support of patients who were involved in this study.

Disclosure

The authors report no conflicts of interest in this work.