ENDOBRONCHIAL stenting achieved closure of complex bronchopleural fistulas in three patients following lung resection, suggesting a potential minimally invasive salvage approach when surgical re-intervention is considered high risk. The case series also highlighted the importance of individualised treatment planning and structured bronchoscopic surveillance.
Bronchopleural fistula (BPF) is a rare but serious postoperative complication of lung resection associated with high morbidity and mortality. The series included three male patients aged 64–68 years who developed complex BPFs after right lower lobectomy.
Clinical presentations included fever, productive cough, purulent sputum, dyspnoea, and radiological evidence of hydropneumothorax and/or pleural infection. Bronchoscopy identified single or multiple fistulas at different bronchial levels.
Each patient underwent individualised bronchoscopic stent placement according to fistula morphology and airway anatomy. Silicone and/or covered metallic stents were used, while three-dimensional airway reconstruction supported planning before the procedures.
All fistulas ultimately closed during follow-up. No cases of stent migration or airway rupture were reported.
Some patients developed mild granulation tissue and bronchomalacic or stenotic airway changes. These complications were managed through surveillance or endoscopic treatment when required.
The cases indicated that successful treatment involved more than endobronchial stenting alone. Adequate pleural drainage, antimicrobial therapy, accurate anatomical assessment, individualised stent design, and structured bronchoscopic surveillance were also important components of management.
The findings suggest that individualised endobronchial stenting may provide a minimally invasive salvage option for carefully selected patients with complex postoperative BPFs, particularly when surgical re-intervention carries a high risk.
However, the observations were based on only three highly selected cases and do not demonstrate universal efficacy or superiority over surgical treatment. Larger comparative studies are needed to establish appropriate patient-selection criteria and determine the safety and long-term effectiveness of this approach.
Reference
Pang L et al. Individualized endobronchial stent therapy for bronchopleural fistulas: a case series. BMC Pulmonary Medicine. 2026. https://doi.org/10.1186/s12890-026-04737-7
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