Successful hemostasis of intractable hemoptysis with endobronchial Watanabe spigots following endoscopic thrombin injection into the bleeding bronchus in an inoperable patient.

Abstract

Patients with hemoptysis refractory to conventional treatments and ineligible for surgical intervention often have a poor prognosis. We report a 74-year-old man with intractable hemoptysis deemed inoperable, successfully treated using a novel approach. Initial management included bronchial artery embolization and endobronchial occlusion with Endobronchial Watanabe Spigots (EWSs), which achieved temporary hemostasis. However, hemoptysis recurred following the dislodgement of spigots. Replacement EWSs were then stabilized using fibrin formed by the reaction between fibrinogen in the bloody sputum and endoscopically administered thrombin. To our knowledge, this is the first reported case demonstrating successful control of intractable hemoptysis using this approach.