Endobronchial silicone spigot in prolonged air leaks: Nationwide study on outcomes and risk factors for treatment failure

Abstract

BackgroundThe endobronchial silicone spigot, also known as the endobronchial Watanabe spigot, is used in bronchoscopic interventions to manage prolonged pulmonary air leakage. However, the outcomes of this procedure have not been thoroughly investigated. MethodsUsing a Japanese national inpatient database from April 2014 to March 2022, we assessed the clinical characteristics and outcomes of all eligible patients who received the endobronchial spigot. We also investigated risk factors associated with treatment failure. Treatment failure was defined as in-hospital death or the need for surgery after bronchial occlusion. ResultsWe analyzed data of 1095 patients who underwent bronchial occlusion using the endobronchial spigot. Among them, 252 patients (23.0%) died during hospitalization, and 403 patients (36.8%) experienced treatment failure. Factors associated with treatment failure included age between 85 and 94 years (odds ratio [OR] 1.83; 95% confidence intervals [CI], 1.04–3.21); male sex (OR 2.43; 95% CI, 1.44–4.11); low Barthel index score; comorbidities of interstitial pneumonia (OR 1.71; 95% CI, 1.18–2.48); antibiotics treatment (OR 1.45; 95% CI, 1.02–2.07); steroids treatment (OR 1.59; 95% CI, 1.07–2.36); and surgery prior to bronchial occlusion (OR 2.08; 95% CI, 1.29–3.35). In contrast, pleurodesis after bronchial occlusion (OR 0.49; 95% CI, 0.32–0.75), and admission to high-volume hospitals were inversely associated with treatment failure (OR 0.58; 95% CI, 0.37–0.90). ConclusionsThe endobronchial Watanabe spigot could be a nonsurgical treatment option for patients with prolonged pulmonary air leaks. Our findings will help identify patients who may benefit from such bronchial interventions.