Endobronchial embolization using a watanabe spigot for persistent air leakage

Background: Endobronchial embolization is an alternative strategy for the management of pneumothorax or empyema with persistent air leakage. The previous reports analyzed heterogeneous populations of patients, including patients with good performance status (PS, 0 or 1). However, the usefulness of Endobronchial embolization for managing persistent air leakage in patients with poor PS (3 or 4) is not well described. Methods: The aim of this study was to evaluate the feasibility of occlusion using an Endobronchial Watanabe Spigot (EWS) to treat persistent air leakage in patients with poor performance status. Charts of 10 consecutive patients who underwent endobronchial embolization using the EWS between March 2013 and April 2014 were retrospectively reviewed. Results: All patients had chronic pulmonary disease; 8 patients had parapneumonic empyema. The Eastern Cooperative Oncology Group performance status (PS) was 3 in 6 patients and 4 in 4 patients. EWS placement at the corresponding bronchus successfully reduced air leakage for all patients, and PS improved in 8 patients. The chest tube could be removed from 4 patients, and successful thoracoplasty was achieved in 3. The other 3 patients died while being managed for pyothorax by fenestration. There were no serious complications associated with EWS insertion. Conclusion: Endobronchial embolization using an EWS for persistent air leakage appeared to be safe and effective, even for compromised patients.