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J.L.N. Medical College, Ajmer, Ajmer, India
PURPOSE: In India TB is the commonest cause of BPF resulting in pneumothorax/pyopneumothorax. We have tried closure of BPF by bronchoscopic instillation of n-butyl-cyano-acrylate (NBCA) glue.
METHODS: Three patients of BPF presented pneumothorax/pyopneumothorax were included. After placement of intercostal chest tube with under-water-seal drainage. A 0.5 mm micro-catheter was introduced through bronchoscope channel and connected with capnograph, it was placed systematically in each segment distally & recorded on capnograph. BPF was suggested by zero tracing on capnograph when the catheter was in particular segment/subsegment having BPF, as it would communicate with environment through chest-tube. Once selection of bronchus was made, 2-5cc 30% n-BCA glue was instilled through catheter after advancing it away from FOB tip because there is risk of damage to the tip. After 1 min. bronchoscope followed by catheter was withdrawn. Closure of BPF was indicated by absent air-bubbling in the under-water-seal drainage & later on complete expansion of lung. Follow-up bronchoscopy showed solidified glue.
RESULTS: All patients had closure of BPF with no recurrence in follow-up.
CONCLUSION: There are few reports on closure of BPF by n-BCA glue. n-BCA solidfies after coming in contact with body fluids & occlude that segmental/sub-segmental bronchus leading to closure of BPF. Proliferation of mucosa/sub-mucosa add to the closure of BPF.
CLINICAL IMPLICATIONS: Bronchoscopic closure of BPF with instillation of n-BCA glue is a novel technique. It is safe, non-invasive & cost effective. It reduces morbidity attributed to BPF & useful in countries where tuberculous BPF accounts for a large number of cases.
DISCLOSURE: M. Vats, None.
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