A novel guidewire-assisted silicone spigot placement for endobronchial occlusion in a complicated airway tract: application of medical thoracoscopy

The Endobronchial Watanabe Spigot (EWS) is a bronchoscopic device with a silicon plug used to occlude a bronchial fistula. Under bronchoscopy, localization of bronchopleural fistula poses a clinical issue and EWS placement in bilateral upper lobes often requires a skillful technique. To facilitate its placement, we introduced a new guidewire technique using two scopes, a bronchoscope and a medical thoracoscope, for localization of the bronchopulmonary fistula using a water-seal test and occlusion of the responsible bronchus without fluoroscopy. We report a case of a patient with chronic empyema with a bronchopleural fistula of the right upper lobe who had undergone a temporary Clagett open-window thoracostomy that was successfully occluded with four spigots using this new method.