Bronchoscopic closure of intubation-related bronchopleural fistulas using combined argon plasma coagulation and fibrin glue: a case series

BACKGROUND: Bronchopleural fistula (BPF) is a rare but potentially life-threatening complication, particularly following endotracheal intubation and prolonged mechanical ventilation. Delayed diagnosis or inadequate management may result in persistent air leakage, recurrent infection, prolonged hospitalization, and high mortality. Although surgical repair remains the standard treatment, it is often associated with considerable morbidity, especially in critically ill or high-risk patients. Consequently, minimally invasive bronchoscopic techniques have emerged as attractive alternatives. METHODS: This case series evaluated the efficacy and safety of a combined bronchoscopic approach using argon plasma coagulation (APC) followed by fibrin glue instillation to close intubation-related bronchopleural fistulas. Six adult patients treated at Rasoul Akram Hospital, Tehran, Iran, during the 2024–2025 calendar year were included. All patients underwent the same intervention without a control group. APC was applied to de-epithelialize the fistula tract, followed by fibrin glue injection under bronchoscopic guidance. The primary outcome was complete fistula closure within 7 days. Secondary outcomes included maintenance of closure at 3 months, recurrence rate, and procedure-related complications. RESULTS: Complete fistula closure was achieved in five of six patients (83.3%), with cessation of air leakage documented within 24–72 h in most cases and sustained throughout the 3-month follow-up period. One 78-year-old patient with severe comorbidities, including diabetes mellitus, chronic kidney disease, respiratory failure, and sepsis, died two days after the procedure; death was attributed to underlying systemic illness rather than the intervention. No procedure-related complications or fistula recurrence were observed among successfully treated patients. CONCLUSION: Combined APC and fibrin glue therapy appears to be a safe, cost-effective, and efficacious minimally invasive option for closing bronchopleural fistulas of varying sizes (small, medium, and selected large fistulas), particularly in patients who are poor surgical candidates. Careful patient selection and optimization of underlying conditions remain essential to achieving optimal outcomes.