Endobronchial Valves for Persistent Air Leak and Bronchopleural Fistula in Children

BACKGROUND: Persistent air leak (PAL) and bronchopleural fistula (BPF) are uncommon but important complications in children, particularly with necrotizing pneumonia, postoperative injury, malignancy, or extracorporeal membrane oxygenation (ECMO). When conservative therapy fails or surgery is high-risk, endobronchial or intrabronchial valve placement has emerged as a minimally invasive bronchoscopic option. This systematic review summarizes the published pediatric experience, focusing on indications, procedural approach, and outcomes. METHODS: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to June 2026, with Google Scholar and reference lists screened; no language limits applied. Eligible studies reported pediatric or late-adolescent patients who underwent bronchoscopic valve placement for PAL, BPF, or pneumothorax with ongoing air leak. Case reports, case series, and observational studies with extractable pediatric data were included. Two reviewers independently screened, assessed eligibility, and abstracted data; findings were synthesized narratively. RESULTS: Thirteen reports were included. Valve placement achieved rapid or eventual air-leak improvement in selected children, including those with necrotizing pneumonia, postoperative air leak, chronic ventilator dependence, malignancy, and ECMO support. Reported complications included valve migration or loosening, granulation tissue, minor hemoptysis, atelectasis, contralateral pneumothorax, and recurrent air leak, although many children underwent valve removal without complication. CONCLUSION: Endobronchial or intrabronchial valve placement may be a useful rescue or bridge therapy for carefully selected children with refractory PAL or BPF. Evidence remains low certainty owing to small samples, retrospective design, inconsistent outcome definitions, and possible publication bias. Prospective multicenter registries with standardized reporting are needed to define optimal selection, timing, and safety.