Introducing a novel “scrub and clotting patch technique” before bronchial occlusion

<bold>Introduction:</bold> While bronchial occlusion with an endobronchial Watanabe spigot (EWS) effectively treats refractory pneumothorax, persistent air leaks from collateral ventilation remain an obstacle with few reported solutions. <bold>Aims and objectives:</bold> We developed a scrub and clotting patch technique and tested whether it controlled collateral ventilation and enhanced treatment success. <bold>Methods:</bold> Twelve patients unsuitable for surgery were treated with the technique along with bronchial occlusion at our hospital between November 2022 and December 2023. The procedure involved inserting a guide sheath into the target bronchial terminus, scrubbing it with a brush, and dispersing 2500 units of thrombin in each session at 4–6 locations through the guide sheath. Subsequently, occlusion with an EWS was performed using the guide sheath and a guiding device. We analyzed patient backgrounds, treatment outcomes, and adverse events. <bold>Results:</bold> The patients (9 male, 3 female) had a median age of 77 years (range 49–84). Diseases underlying refractory pneumothorax included interstitial pneumonia in 10 cases, emphysema in 6 (5 of which also had pulmonary fibrosis), rheumatoid arthritis in 3, and lung cancer in 2. The median number of EWS used for occlusion per patient was 5 (range 2–8). Ultimately, air leaks were conservatively stopped in 11 of 12 cases (92%). Among these 11, 7 required additional pleurodesis. No serious complications were observed during or immediately after the procedure; however, one case experienced a recurrence of CO₂ narcosis after cessation of the air leak. <bold>Conclusion:</bold> These results suggest the promising potential of the scrub and clotting patch technique in managing refractory pneumothorax.