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selected reports: Kazuo Takaoka, Shoichi Inoue, and Seiji Ohira Central Bronchopleural Fistulas Closed by Bronchoscopic Injection of Absolute Ethanol* Chest 2002; 122: 374-378 [Abstract] [Full text] [PDF]

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Central Bronchopleural Fistulas Closed by Bronchoscopic Injection of Absolute Ethanol

Satinder K. Jain   (15 July 2002)

Central Bronchopleural Fistulas Closed by Bronchoscopic Injection of Absolute Ethanol 15 July 2002
Satinder K. Jain, Cardiothoracic & Vascular Surgeon Senior Consultant, Batra Hospital & Medical Research Centre, New Delhi, India Send letter to journal: Re: Central Bronchopleural Fistulas Closed by Bronchoscopic Injection of Absolute Ethanol satinder_jain{at}yahoo.com Satinder K. Jain	Dear Sir, I read with interest the report by Kazuo Takaoka, Shoichi Inoue, and Seiji Ohira on the above topic. Seems a novel approach which has worked well with their patients so far. My concern relates to the mechanism of fistula closure which is not very clear. I believe that the injection of absolute alcohol in the submucosa will surely lead to intense inflammatory response and granulation formation. Granulation tissue at bronchial stump is one of the commonest precursors of bronchopleural fistula formation. We also know that there is no real healing of bronchial stump since it is just cooptation of two mucosal surfaces held in place by staples/sutures and scarring at end of bronchial stump. As we know from our experience of alcohol injection for intercostal/trigeminal neuralgia, there occurs necrosis of tissues. Probably, something similar would happen by submucosal injection of absolute ethanol in the central BPF. The eventual sloughing of necrosed tissue might widen the fistula and formation of granulation tissue may prevent eventual healing of BPF. Before, this method is widely used, some sort of animal study is in order to better understand the pathophysiology and mechanisms involved.