Validity of pleurodesis with bleomycin by pigtail versus chest tube in malignant pleural effusion

Background: Pleural drainage is the preferred treatment for patients with symptomatic malignant pleural effusion. Insertion of a large bore chest tube for drainage prior to chemical pleurodesis is a standard treatment procedure. Small sized catheters (pigtail) are another option. However, for use in pleural drainage and pleurodesis, the optimal size of chest drains is still debatable. The aim of the study: Comparing the consequences and efficacy of bleomycin in pleurodesis using small sized pigtail (10-12 Fr) versus chest tube (24-30 Fr) in malignant pleural effusion. Patients and methods: A total of 130 patients with malignant pleural effusion were enrolled in this study. The patients were divided into two categories, Group A: a small sized pigtail catheter (10-12 French) was used in 72 patients and group B: a chest tube (24-30 French) was used in 58 patients. Male patients were 19 in group A and 18 in group B, with nearly same age range (51-67) and (55-70) year, respectively. All patients with manifested coagulopathy, loculated effusion or serious comorbidity were excluded. Results: Comparative results found that lung cancer was the main cause in both groups: adenocarcinoma 38.9 % in group A and 37.9 % in group B, followed by squamous cell carcinoma 11.1 % versus 6.9 %, respectively. Most body cancers were presented in both groups except stomach cancer was 0 % in both groups. Total success was slightly higher in group A 75 % compared to 72.4 % in group B but not statistically significant. Total hospital stay, postoperative pain score and dyspnea incidence were significantly less in group A where small pigtails were inserted. Conclusion: The chemical pleurodesis with bleomycin using small pore catheter (Pigtail) in MPE management is more effective, more patient- tolerable, than chest tube method. It is recommended to use of the pigtail drainage system rather than a chest tube in the treatment of MPE.