THE EFFICACY OF ENDOBRONCHIAL VALVE THERAPY IN COMPLEX TREATMENT OF BRONCHO-PLEURAL FISTULAS.

The aim of our investigation was the assessment of the efficacy of endobronchial valve (EBV) therapy in the complex treatment BPF. The presented study has been carried out in several centers of Georgia (basically in the National Center for Tuberculosis and Lung Diseases). The study group was selected from 30 patients with BPF, who underwent endobronchial valve therapy and signed the informed consent to participate in the study. The corresponding control group was selected from 28 patients with BPF, who underwent conservative therapy by multiple thoracocentesis, chest tube insertion and also surgery and signed the informed consent to participate in the study. EBV therapy has been carried out by combined using the rigid (Friedel) and flexible (Olympus and Pentax) bronchoscopes. EBV therapy has been performed by valves of Medlung Ltd.The quality of life in study and control groups has been studied by the Saint George Respiratory Questionnaire (SGRQ). Statistical analysis performed by software SPSS 22.0. BPF closure after EBV intervention in the study group was in 28 cases from 30 and in 19 cases from 28 in the control group. Respectively the relapse cases after EBV intervention or surgery showed that 2 cases (6.7%) were identified in the study group and 9 cases (32.14%) - in the control group. Difference between groups was statistically significant (χ2=6.1163; p=0.0134). The duration of the pre-surgery period in the study group was significantly lower, 0.89 (SD - 1.45) days compared to the control group, 11.04 (SD -17.0) days. The mean value of hospital delay after EBV intervention was 8.0 (SD - 14.1) days, the corresponding value in the control group was 36.9 (SD - 47.4) days (the difference was significant p=0.0023). The mean duration of the chest tube insertion in the study group after EBV therapy - 2.6 (SD - 1.7) days. Analogous values in control group was 18.4 (SD - 20.2) days (p=0.0001). The assessment of the quality of life by SGRQ in study and control groups showed that the total SGRQ score was decreased significantly during 6 months from 65.4 to 42.3 (p<0.001), i.e. by 23.1. The total SGRQ score in the control group was not decreased significantly during 6 months (from 63.6 to 58.4, p=NS). The dynamics for symptom domain was also significant -27.6 (p=0.008), for activity domain -31.5 (p<0.001), for impact domain -17.0 (p=0.011). EBV therapy revealed high efficacy in the treatment of BPF. Compared to traditional methods, such as conservative therapy (thoracentesis, chest tube insertion) and surgery it was expressed by significantly lower frequency of relapses, lower duration of chest tube insertion, and lower duration of hospital delay.

Stenting of the left main bronchus in cicatrical post-TB bronchial stenosis (case report).

The primary treatment of endobronchial tuberculosis complicated by bronchial stenosis is antituberculous chemotherapy. Surgical resection and bronchoplastic reconstruction has long been the standard treatment. However, bronchoscopic intervention is essential to restore the patency of the involved bronchus and controlling TB. To our best knowledge this is a first report of bronchial stenting in Georgian Republic. We performed this procedure in cooperation with interventional cardiologists from Cardiac Catheterization Laboratory "HELSY T.E." Ltd. which have wide experience in stenting manipulations. A 24-year-old woman, after treatment with antituberculous medications for pulmonary tuberculosis, suffered by cough, dyspnea, wheezing. CT scan showed stricture of the left main bronchus starting from bifurcation to the end and having a lumen diameter 2mm. Bronchoscopic examination revealed focal narrowing to pinhole size to the left main bronchus with severe fibrotic changes. We decided to perform endobronchial stenting. Under general anesthesia, balloon-expendable, metallic, non-covered stent (Medtronic) was inserted across the stenotic lesion and was expanded under the pressure of 9 atmospheres using Indeflator Perouse Medical. Bronchography, taken immediately after stent insertion, showed an expanded left main bronchus. Postoperatively the patient did well. Chest radiographs taken after 6 days demonstrating a fully expanded stent, mediastinal repositioning towards the midline and normal aeration of the left lung. Patient's dyspnea was much improved. The patient has now been asymptomatic for 3 months. In conclusion, this case describes a patient with a cicatrical post-TB bronchial stenosis that was effectively treated by bronchoscopic stenting, which is alternative to surgical resection thus avoiding unwarranted thoracotomies and providing quality of life.