ULTRASOUND-GUIDED SMALL-BORE ELECATH TUBE INSERTION FOR THE RAPID SCLEROTHERAPY OF MALIGNANT PLEURAL EFFUSION

Background: Traditional pleurodesis for malignant pleural effusion is performed by large-bore chest tube insertion with the instillation of sclerosing agents after the compressed lung re-expansion and pleural f luid drainage of 100-150 ml/day, This study was carried out to evaluat e the possibility of rapid sclerotherapy for malignant pleural effusio ns by insertion of a small-bore Elecath tube (12-French) under ultraso und guidance and intrapleural injection of bleomycin 60 IU. Methods: T wenty-six patients, with 28 cytopathologically proven malignant pleura l effusions (two patients had bilateral pleural effusions) and receivi ng the insertion of the Elecath tube for drainage, were included in ou r series, This rapid and short-term sclerosing method was performed an d completed by intrapleural injection of bleomycin when the pleural ef fusion had been clearly drained by the small-bore Elecath tube and the compressed lung had fully re-expanded on follow-up chest radiographs. Results: Twenty patients with 22 pleural effusions underwent the intr apleural injection of bleomycin, with the results of pleurodesis being complete response 41% (9/22), partial response 36% (8/22) and failure 23% (5/22), Interestingly, among the 17 successful procedures of pleu rodesis (complete response and partial response), 71% (12) procedures could be completed within 2 days (seven within one day and five within 2 days), The remaining unsuccessful procedures carried out on six pat ients without the injection of bleomycin were due to a non-re-expanded lung (n = 3) and inadequate drainage (n = 3); of these, four patients also received the large-bore chest tube insertion after the removal o f the Elecath tube, but the compressed lung still could not re-expand, The complications of the bleomycin injection were fever [77% (17/22)] , vomiting [14% (3/22)] and hiccup [5% (1/22)]. Conclusion: The method of rapid sclerotherapy for malignant pleural effusions by small-bore Elecath tube is promising, with a success rate achieving 77%, usually within 2 days.