Individualized endobronchial stent therapy for bronchopleural fistulas: a case series

Bronchopleural fistula (BPF) is a rare but serious postoperative complication following lung resection, associated with high morbidity and mortality. Endoscopic stent occlusion has emerged as a minimally invasive treatment option, particularly for patients unsuitable for reoperation. We present a case series of three male patients (aged 64–68 years) who developed complex BPFs after right lower lobectomy. Clinical presentations included fever, productive cough, purulent sputum, dyspnea, and radiological evidence of hydropneumothorax and/or pleural infection. Bronchoscopic examination revealed single or multiple fistulas at different bronchial levels. Each patient underwent individualized bronchoscopic stent placement using silicone and/or covered metallic stents tailored to fistula morphology and airway anatomy. Three-dimensional airway reconstruction was used to support preprocedural planning. All fistulas ultimately closed during follow-up. No stent migration or airway rupture occurred; however, mild granulation tissue and bronchomalacic or stenotic airway changes were observed in some patients and were managed with surveillance or endoscopic treatment as required. This series illustrates the technical feasibility and potential clinical value of individualized endobronchial stenting for selected patients with complex postoperative BPFs. Successful management depended not only on fistula closure, but also on adequate pleural drainage, antimicrobial therapy, accurate anatomical assessment, individualized stent design, and structured bronchoscopic surveillance. Individualized endobronchial stenting may provide a minimally invasive salvage option for carefully selected patients with complex postoperative BPFs, particularly when surgical re-intervention is considered high risk. These observations from three highly selected cases should not be interpreted as evidence of universal efficacy or superiority over surgical treatment. Larger comparative studies are needed to define patient-selection criteria, safety, and long-term effectiveness.