Bronchoscopic Approaches to Managing Airway Wall Defects in Malignant Fistulas and Transplant Associated Defects

Abstract Purpose of review Airway wall defects, including malignant aero-digestive fistulas, bronchopleural fistulas, and transplant-associated anastomotic dehiscence, represent some of the most challenging complications in interventional pulmonology. This review aims to outline contemporary bronchoscopic strategies for malignant and transplant-related airway defects and evaluate the latest therapeutic options. Recent findings In malignant airway defects, early bronchoscopic intervention can restore airway–gastrointestinal separation, reduce aspiration, and allow systemic cancer therapy to proceed. Covered airway and esophageal stents remain fundamental, complemented by endobronchial valves, sealants, autologous blood patches, and Amplatzer-type occlusion devices for complex, non-stentable defects. In transplant-associated airway complications, graded ISHLT-guided approaches are recommended. Silicone, hybrid, and 3D-printed patient-specific stents effectively manage anastomotic and non-anastomotic defects. Summary Modern bronchoscopic therapies provide durable palliation, improved airway stability, and expanded treatment eligibility for previously inoperable patients. However, most evidence is observational, highlighting the need for standardized outcome reporting and prospective registries to guide future practice.