Endoscopic management of large, postresection bronchopleural fistulae with methacrylate adhesive (Super Glue)

Bronchopleural fistulae that occur following pulmonary resection are usually managed by direct, operative closure. In complex cases, in which the risk of repeat thoracotomy is great, other means may be preferable. We report two patients, one with cystic fibrosis and one with extensive radiation fibrosis post-Askin's tumor, in whom the risk of thoracotomy was considered to be prohibitive. Both had a large fistula between the pleural cavity and a segmental bronchus from the right upper lobe. The cystic fibrosis patient had recurrent massive bleeding from the pleural space. A Teflon catheter was passed through a flexible bronchoscope and Super Glue (butyl or methyl methacrylate) was deposited into the fistula. In both cases, the fistula resolved promptly. One patient developed a large, recurrent granuloma at the site of the fistula requiring endoscopic resection. We believe that tissue adhesive may be a reasonable approach to the management of large bronchopleural fistulas when the risk of operative closure is great.