Study of pleurodesis using ethanolamine oleate through ultrasound-guided pigtail

Abstract

BackgroundMalignant pleural effusion (MPE) is a common and serious condition that is associated with poor quality of life, morbidity and mortality.AimStudy of pleurodesis using ethanolamine oleate (ETH) through ultrasound-guided pigtail to evaluate the efficacy and complications of ETH and pigtail.DesignThirty-three patients with MPE were included and were subjected to history taking, clinical examination, chest radiographs (on admission, every day before pleurodesis to ensure complete lung expansion and to exclude pneumothorax, every day after pleurodesis till the removal of the catheter and on follow-up – 2 months after pleurodesis – to check for reaccumulation of pleural effusion), chest sonography, pleural tapping, chest computed tomography scan (in some patients), pleural biopsy using Abram’s needle or through ultrasonography (in some cases), lymph node biopsy (in some cases) and spirometry before and 2 months after pleurodesis. Patients were subjected to pigtail catheter insertion using chest sonography. When the amount of effusion became less than 100 ml/day and when the chest radiography shows complete lung expansion and there is no evidence of bronchopleural fistula, pleurodesis with ETH was done. Then after 12 h, the pigtail was connected to a drainage device. Follow-up radiographs were done every day till the removal of the catheter. When the amount of the effusion became less than 100 ml/day, the catheter was removed. Assessment of the response was made after 2 months of pleurodesis, before death that may occur to the patient within 3 to 12 months after diagnosis. Despite the progress in cancer treatment, the management of MPE remains palliative, with median survival ranging from 3 to 12 months.ResultsComplete response was 81.8% of studied cases, while no/partial response was 18.2%. Pleurodesis complications were fever (21.1%), chest pain (33.3%), nausea (24.2%), vomiting (12.1%) and hypotension (6.1%). Pigtail complications were pigtail obstruction (3.03%), chest pain (3.03%) and obstruction and pain (12.12%) of the studied cases. There was a decrease in FVC% and FEV1% 2 months after pleurodesis. However, no significant difference as regards actual (measured) FEV1/FVC% before and 2 months after pleurodesis in all cases. Whereas, complete response was 81.8% by CXR and chest ultrasound.ConclusionETH injection through pigtail was safe and effective in pleurodesis of MPE.