Bronchoscopy-Guided Placement of Petrolatum Gauze For Closure of Peripheral Bronchopleural Fistula in Humans

Bronchopleural fistula (BPF), defined as a pathological communication between the bronchial airways and the pleural space, carries high mortality (18%-50%) due to complications like infection and respiratory failure. Current treatments, including conservative management and invasive surgery, face limitations such as variable efficacy, high trauma, and inapplicability to high-risk patients. An innovative bronchoscopy-guided petrolatum gauze occlusion protocol provides a minimally invasive, cost-effective solution for patients with small to medium-sized bronchopleural fistulas (≤5 mm) who are not candidates for surgery. Key steps included precise fistula localization via. methylene blue dilution injection, tailored gauze sizing, and bronchoscopic placement under direct visualization. Stability was ensured through forceps-guided positioning or supplemental metal stents in anatomically challenging cases. Post-procedure monitoring included chest X-ray, CT imaging, and clinical assessments at 1 day, 1 week, and 1 month. In a retrospective study of 19 patients with peripheral BPFs ≤ 5 mm who met predefined inclusion criteria (e.g., failed prior conservative therapy, high surgical risk) and exclusion criteria (e.g., untreated empyema, fistulas involving central airways), petrolatum gauze occlusion achieved 94.7% efficacy (18/19) at one week, with a low infection rate (15.8%). The observed efficacy, while promising, should be interpreted within the context of the study's limitations, including its small sample size (n = 19), single-center retrospective design, and potential for selection bias. Consequently, the generalizability of these findings to broader patient populations or other institutional settings may be limited. This cost-effective, adaptable technique demonstrates high success in sealing small-to-medium fistulas (≤5 mm), offering a safe alternative for high-risk populations, particularly in resource-limited settings. This article describes in detail the indications for this method, preoperative evaluation, intraoperative manipulation, and postoperative testing.